MEDICARE: SUSAN A ROSA OTR

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	174400000X	Specialist	553-026	WI

General Provider Information

NPI Number	:	1386884849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN A ROSA OTR

Provider Business Mailing Address
First Line	:	3427 VIBURNUM DR
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53705-1442
Country	:	US
Telephone Number	:	608-236-9374
Fax Number	:

Provider Business Practice Location Address
First Line	:	3427 VIBURNUM DR
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53705-1442
Country	:	US
Telephone Number	:	608-236-9374
Fax Number	:

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

Provider Enumeration Date	:	02/24/2009
Last Update Date	:	02/24/2009

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Directions to “ SUSAN A ROSA OTR” Practice Location

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