MEDICARE: NINA DEL ROSARIO OTR/L

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	225X00000X	Occupational Therapist	014609-1	NY
2	225XP0200X	Pediatric Occupational Therapist	4153	AZ

General Provider Information

NPI Number	:	1184881146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NINA DEL ROSARIO OTR/L

Provider Business Mailing Address
First Line	:	PO BOX 750877
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-0877
Country	:	US
Telephone Number	:	718-261-0211
Fax Number	:

Provider Business Practice Location Address
First Line	:	5901 W BEHREND DR
Second Line	:	APT 2065
City	:	GLENDALE
State	:	AZ
Zip	:	85308-6943
Country	:	US
Telephone Number	:	718-288-4434
Fax Number	:

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

Provider Enumeration Date	:	05/19/2008
Last Update Date	:	12/07/2011

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