Individual
BRIAN ROSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTS
Contact information
Practice address
601 S MARTIN LUTHER KING JR DR FL 432, WINSTON SALEM, NC 27110-0003
(336) 750-3174
Mailing address
PO BOX 2272, ELIZABETH CITY, NC 27906-2272
(252) 337-4781
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
09/04/2020
Last updated
09/05/2020
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