Healthcare Provider Details

I. General information

NPI: 1992819783
Provider Name (Legal Business Name): ROSEMARY ADOLPH MOT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 08/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MCK-3752- RAV 4 RAV 4--TRAVEL
MARSHALL TX
75670
US

IV. Provider business mailing address

609 BLACK ST
MARSHALL TX
75670-5204
US

V. Phone/Fax

Practice location:
  • Phone: 903-934-2593
  • Fax:
Mailing address:
  • Phone: 903-935-7330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number107750
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code225XH1300X
TaxonomyHuman Factors Occupational Therapist
License Number006279-1
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: