MEDICARE: KELLY ANN ROSA OTR/L

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	225X00000X	Occupational Therapist	014404-1	NY

General Provider Information

NPI Number	:	1083989818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY ANN ROSA OTR/L

Provider Business Mailing Address
First Line	:	2515 AVENUE L
Second Line	:	THE GIL HODGES SCHOOL
City	:	BROOKLYN
State	:	NY
Zip	:	11210-4546
Country	:	US
Telephone Number	:	718-338-9011
Fax Number	:	718-338-9074

Provider Business Practice Location Address
First Line	:	2515 AVENUE L
Second Line	:	THE GIL HODGES SCHOOL
City	:	BROOKLYN
State	:	NY
Zip	:	11210-4546
Country	:	US
Telephone Number	:	718-338-9011
Fax Number	:	718-338-9074

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

Provider Enumeration Date	:	03/13/2012
Last Update Date	:	03/13/2012

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