Provider Demographics
NPI:1568914075
Name:IBRAHIM, RAMI NABIEL (OTR)
Entity Type:Individual
Prefix:
First Name:RAMI
Middle Name:NABIEL
Last Name:IBRAHIM
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:RAMI
Other - Middle Name:NABIEL
Other - Last Name:IBRAHIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:3724 W 141ST ST
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66224-1122
Mailing Address - Country:US
Mailing Address - Phone:913-980-0766
Mailing Address - Fax:
Practice Address - Street 1:11400 HIDDEN LAKE DR
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64133-7409
Practice Address - Country:US
Practice Address - Phone:620-778-4833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-31
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO201-502-2267174400000X
KS1703158174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist