MEDICARE: ANDREA ROSALES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224Z00000X	Occupational Therapy Assistant	212532	TX

General Provider Information

NPI Number	:	1073901450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA ROSALES

Provider Business Mailing Address
First Line	:	922 E SONTERRA BLVD
Second Line	:	APT 8305
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-4736
Country	:	US
Telephone Number	:	830-379-9308
Fax Number	:	830-401-4990

Provider Business Practice Location Address
First Line	:	922 E SONTERRA BLVD
Second Line	:	APT 8305
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-4736
Country	:	US
Telephone Number	:	830-379-9308
Fax Number	:	830-401-4990

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/07/2015
Last Update Date	:	01/07/2015

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Directions to “ ANDREA ROSALES ” Practice Location

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