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General NPI Number Information
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NPI Number | 1033732177
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Entity Type | Individual
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Provider Name | ROSALINE ELIZABETH PRINCE OTR/L
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Gender | Female
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Dates
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Enumeration Date | 05/23/2020
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Last Update Date | 02/11/2021
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Provider Practice Location Address
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Address Line | 4460 CELEBRATION BLVD
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City | ACWORTH
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State | GA
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Zip | 30101-1105
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Country | US
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Telephone | 678-594-3570
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Fax |
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Provider Business Mailing Address
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Address Line | 120 MILLBROOK TRCE
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City | MARIETTA
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State | GA
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Zip | 30068-3751
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Country | US
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Telephone | 770-367-5369
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT007666
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License Number State | GA
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