Individual
MICHAEL DEROSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
1200 QUAIL ST STE 100, NEWPORT BEACH, CA 92660-2706
(949) 475-1002
Mailing address
17 RIPTIDE CT, NEWPORT BEACH, CA 92663-2105
(818) 414-5593
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5078
CA
Other
Enumeration date
02/26/2020
Last updated
02/26/2020
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