Individual
MS. CHRISTA LOUISE ROSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1501 EAST MADISON STREET, SOUTH BEND, IN 46617
(574) 274-5492
Mailing address
1501 E MADISON ST, SOUTH BEND, IN 46617-2505
(574) 274-5492
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5202001236
MI
Other
Enumeration date
05/08/2023
Last updated
05/08/2023
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