MEDICARE: MS. ALYCIA ROZEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XM0800X	Mental Health Occupational Therapist	001215	OH
2	225XP0200X	Pediatric Occupational Therapist	001215	OH

General Provider Information

NPI Number	:	1043613524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALYCIA ROZEN

Provider Business Mailing Address
First Line	:	3450 GOLDEN AVE
Second Line	:	UNIT 11
City	:	CINCINNATI
State	:	OH
Zip	:	45226-2065
Country	:	US
Telephone Number	:	513-321-1329
Fax Number	:

Provider Business Practice Location Address
First Line	:	3450 GOLDEN AVE
Second Line	:	UNIT 11
City	:	CINCINNATI
State	:	OH
Zip	:	45226-2065
Country	:	US
Telephone Number	:	513-321-1329
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2014
Last Update Date	:	09/29/2014

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