MEDICARE: ROSE BEAUSOLEIL

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	222Q00000X	Developmental Therapist

General Provider Information

NPI Number	:	1629324744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSE BEAUSOLEIL

Provider Business Mailing Address
First Line	:	2630 E BEL AIRE DR
Second Line	:	301
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-6600
Country	:	US
Telephone Number	:	847-212-1035
Fax Number	:

Provider Business Practice Location Address
First Line	:	2630 E BEL AIRE DR
Second Line	:	301
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-6600
Country	:	US
Telephone Number	:	847-212-1035
Fax Number	:

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

Provider Enumeration Date	:	07/26/2012
Last Update Date	:	07/26/2012

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