MEDICARE: MRS. MICHELLE LEANN ROSEN OTRL

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	225XN1300X	Neurorehabilitation Occupational Therapist	981	MT

General Provider Information

NPI Number	:	1427108679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MICHELLE LEANN ROSEN OTRL

Provider Business Mailing Address
First Line	:	1111 MEADOW LN
Second Line	:
City	:	BOZEMAN
State	:	MT
Zip	:	59715-9248
Country	:	US
Telephone Number	:	406-600-9584
Fax Number	:

Provider Business Practice Location Address
First Line	:	2135 CHARLOTTE ST
Second Line	:	SUITE 3
City	:	BOZEMAN
State	:	MT
Zip	:	59718-2739
Country	:	US
Telephone Number	:	406-586-8030
Fax Number	:	406-586-8036

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

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	09/09/2016

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