Provider Demographics
NPI:1871775353
Name:RABBETH, ELLE (OT/L)
Entity type:Individual
Prefix:
First Name:ELLE
Middle Name:
Last Name:RABBETH
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3416
Mailing Address - Street 2:
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87533-3416
Mailing Address - Country:US
Mailing Address - Phone:505-583-2540
Mailing Address - Fax:
Practice Address - Street 1:HIGHWAY 341 #143
Practice Address - Street 2:
Practice Address - City:LA MADERA
Practice Address - State:NM
Practice Address - Zip Code:87539
Practice Address - Country:US
Practice Address - Phone:505-583-2540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM989225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist