Provider Demographics
NPI:1033323480
Name:BOHANAN, ROSEANNE B (OTRL)
Entity Type:Individual
Prefix:MS
First Name:ROSEANNE
Middle Name:B
Last Name:BOHANAN
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:MS
Other - First Name:ROSEANNE
Other - Middle Name:
Other - Last Name:BOSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:8916 HOOK STREET
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322
Mailing Address - Country:US
Mailing Address - Phone:219-838-1648
Mailing Address - Fax:
Practice Address - Street 1:8916 HOOK STREET
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322
Practice Address - Country:US
Practice Address - Phone:219-838-1648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31000441A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist