Provider Demographics
NPI:1003450495
Name:ROZOV, ADEE (OTR/L)
Entity Type:Individual
Prefix:
First Name:ADEE
Middle Name:
Last Name:ROZOV
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2837 E VISTA ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-5424
Mailing Address - Country:US
Mailing Address - Phone:818-512-2223
Mailing Address - Fax:
Practice Address - Street 1:18881 VON KARMAN AVE STE 1240
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-8535
Practice Address - Country:US
Practice Address - Phone:949-885-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-30
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20189225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist