MEDICARE: LAURA MARIE ROSA

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	OT3257	OH

General Provider Information

NPI Number	:	1598411365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA MARIE ROSA

Provider Business Mailing Address
First Line	:	12675 BROCKWAY DR
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44125-5563
Country	:	US
Telephone Number	:	216-394-1214
Fax Number	:

Provider Business Practice Location Address
First Line	:	12675 BROCKWAY DR
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44125-5563
Country	:	US
Telephone Number	:	216-394-1214
Fax Number	:

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

Provider Enumeration Date	:	03/01/2022
Last Update Date	:	03/01/2022

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Directions to “ LAURA MARIE ROSA ” Practice Location

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