Healthcare Provider Details

I. General information

NPI: 1861566069
Provider Name (Legal Business Name): JEANETTE MARIE ROSENSTEEL OTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JEANETTE MARIE ROSENSTEEL OTA

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 S MAIN ST
BOONSBORO MD
21713-1203
US

IV. Provider business mailing address

308 DEVONSHIRE RD
HAGERSTOWN MD
21740-4508
US

V. Phone/Fax

Practice location:
  • Phone: 301-432-1528
  • Fax: 301-432-4538
Mailing address:
  • Phone: 301-797-8758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberA00773
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: