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General NPI Number Information
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NPI Number | 1336458801
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Entity Type | Individual
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Provider Name | MS. ANGELA MICHELLE ROSE
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Gender | Female
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Dates
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Enumeration Date | 10/01/2010
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Last Update Date | 09/14/2021
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Provider Practice Location Address
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Address Line | 1230 JOHNSON FERRY PL STE G10
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City | MARIETTA
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State | GA
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Zip | 30068-2045
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Country | US
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Telephone | 770-321-6705
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Fax | 404-551-3891
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Provider Business Mailing Address
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Address Line | 1225 GLEN HAVEN LN
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City | BATAVIA
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State | OH
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Zip | 45103-1134
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Country | US
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Telephone | 513-633-4517
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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 | OT007921
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License Number State | GA
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