Provider Demographics
NPI:1346924750
Name:PRISMATIC PELVIC HEALTH, PLLC
Entity Type:Organization
Organization Name:PRISMATIC PELVIC HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:THENNES
Authorized Official - Suffix:
Authorized Official - Credentials:MOT, OTR/L
Authorized Official - Phone:563-265-1154
Mailing Address - Street 1:33 COBBLESTONE LN
Mailing Address - Street 2:
Mailing Address - City:LE CLAIRE
Mailing Address - State:IA
Mailing Address - Zip Code:52753-9249
Mailing Address - Country:US
Mailing Address - Phone:563-579-5662
Mailing Address - Fax:
Practice Address - Street 1:2010 E 38TH ST STE 201B
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-1179
Practice Address - Country:US
Practice Address - Phone:563-265-1154
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty