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General NPI Number Information
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NPI Number | 1164903829
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Entity Type | Individual
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Provider Name | MRS. GRACE ROSSI
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Gender | Female
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Dates
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Enumeration Date | 08/22/2018
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Last Update Date | 08/22/2018
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Provider Practice Location Address
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Address Line | 404 E HARFORD ST
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City | MILFORD
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State | PA
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Zip | 18337-1028
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Country | US
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Telephone | 800-773-9044
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Fax |
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Provider Business Mailing Address
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Address Line | 108 HIGH ST
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City | OGDENSBURG
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State | NJ
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Zip | 07439-1218
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Country | US
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Telephone | 201-779-3610
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 46TA09145100
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License Number State | NJ
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