Provider Demographics
NPI:1013040732
Name:RUETH, ROSANNE C (OT)
Entity Type:Individual
Prefix:
First Name:ROSANNE
Middle Name:C
Last Name:RUETH
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22W056 PINEGROVE CT
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-7900
Mailing Address - Country:US
Mailing Address - Phone:630-479-1542
Mailing Address - Fax:630-942-1542
Practice Address - Street 1:22W056 PINEGROVE CT
Practice Address - Street 2:
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-7900
Practice Address - Country:US
Practice Address - Phone:630-479-1542
Practice Address - Fax:630-942-1542
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist