Individual
MARY ANN ROSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
125 BYRD AVE, NEENAH, WI 54956-4015
(920) 725-7869
Mailing address
125 BYRD AVE, NEENAH, WI 54956-4015
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
382-27
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40875700
—
WI
Enumeration date
07/16/2008
Last updated
07/16/2008
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