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General NPI Number Information
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NPI Number | 1912144627
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Entity Type | Individual
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Provider Name | JENNIFER JO ROSOCHACKI OTR
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Gender | Female
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Dates
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Enumeration Date | 01/16/2009
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Last Update Date | 01/16/2009
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Provider Practice Location Address
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Address Line | 43650 GARFIELD RD SUITE 103
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038-1120
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Country | US
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Telephone | 586-228-2075
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Fax |
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Provider Business Mailing Address
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Address Line | 46116 SPRINGHILL CT
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City | SHELBY TOWNSHIP
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State | MI
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Zip | 48317-4052
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Country | US
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Telephone | 586-731-1422
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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 | 5201000651
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License Number State | MI
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