MEDICARE: CHELSEA ROSE MS/OTR

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	OT.0003594	CO

General Provider Information

NPI Number	:	1992135750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHELSEA ROSE MS/OTR

Provider Business Mailing Address
First Line	:	1332 VILLAGE PARK CT
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-1757
Country	:	US
Telephone Number	:	720-402-1977
Fax Number	:

Provider Business Practice Location Address
First Line	:	1332 VILLAGE PARK CT
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-1757
Country	:	US
Telephone Number	:	720-402-1977
Fax Number	:

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

Provider Enumeration Date	:	11/14/2013
Last Update Date	:	12/21/2016

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