Healthcare Provider Details

I. General information

NPI: 1194377622
Provider Name (Legal Business Name): ALMA NANCY ROSALES OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2019
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 SAINT JOSEPH AVE
BERRIEN SPRINGS MI
49103-1583
US

IV. Provider business mailing address

360 1ST ST
WATERVLIET MI
49098-5112
US

V. Phone/Fax

Practice location:
  • Phone: 269-471-7725
  • Fax:
Mailing address:
  • Phone: 269-849-6729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201009912
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: