Provider Demographics
NPI:1336153121
Name:RASHID, KELLI E (OTRL)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:E
Last Name:RASHID
Suffix:
Gender:F
Credentials:OTRL
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 3497
Mailing Address - Street 2:
Mailing Address - City:STURTEVANT
Mailing Address - State:WI
Mailing Address - Zip Code:53177-0300
Mailing Address - Country:US
Mailing Address - Phone:877-552-2996
Mailing Address - Fax:866-245-8064
Practice Address - Street 1:125 SOUTH STREET
Practice Address - Street 2:SUITE B
Practice Address - City:KEWANEE
Practice Address - State:IL
Practice Address - Zip Code:61443
Practice Address - Country:US
Practice Address - Phone:309-852-2200
Practice Address - Fax:309-852-2402
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056005158225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$001Medicaid
IL$$$$$$$$$001Medicaid