MEDICARE: MARA ROSEN

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	OT18343	FL
2	225800000X	Recreation Therapist

General Provider Information

NPI Number	:	1265307359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARA ROSEN

Provider Business Mailing Address
First Line	:	3908 W MULLEN AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-4427
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3908 W MULLEN AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-4427
Country	:	US
Telephone Number	:	847-477-5514
Fax Number	:

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

Provider Enumeration Date	:	10/08/2025
Last Update Date	:	10/08/2025

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Directions to “ MARA ROSEN ” Practice Location

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