Provider Demographics
NPI:1386841245
Name:RATHBUN, CORRINE ELIZABETH (LAC, LMT)
Entity Type:Individual
Prefix:
First Name:CORRINE
Middle Name:ELIZABETH
Last Name:RATHBUN
Suffix:
Gender:F
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 OREGON ST
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54902-5967
Mailing Address - Country:US
Mailing Address - Phone:920-216-9791
Mailing Address - Fax:920-385-4995
Practice Address - Street 1:711 OREGON ST
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54902-5967
Practice Address - Country:US
Practice Address - Phone:920-216-9791
Practice Address - Fax:920-385-4995
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2710-046225700000X
WI714-55171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist