Provider Demographics
NPI:1033732177
Name:PRINCE, ROSALINE ELIZABETH (OTR/L)
Entity Type:Individual
Prefix:
First Name:ROSALINE
Middle Name:ELIZABETH
Last Name:PRINCE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ROSALINE
Other - Middle Name:ELIZABETH
Other - Last Name:CASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:120 MILLBROOK TRCE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-3751
Mailing Address - Country:US
Mailing Address - Phone:770-367-5369
Mailing Address - Fax:
Practice Address - Street 1:4460 CELEBRATION BLVD
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-1105
Practice Address - Country:US
Practice Address - Phone:678-594-3570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-23
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT007666225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist