Provider Demographics
NPI:1063690089
Name:KANE, TABATHA ELLEN (OTR/L)
Entity type:Individual
Prefix:MS
First Name:TABATHA
Middle Name:ELLEN
Last Name:KANE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17017 N 12TH ST
Mailing Address - Street 2:UNIT 1133
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-2026
Mailing Address - Country:US
Mailing Address - Phone:480-768-7267
Mailing Address - Fax:
Practice Address - Street 1:5707 E SAINT JOHN RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-6417
Practice Address - Country:US
Practice Address - Phone:602-482-3226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3411225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist