Provider Demographics
NPI:1043416100
Name:ROSENBALM, JEANNIE MARIE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:JEANNIE
Middle Name:MARIE
Last Name:ROSENBALM
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4465 SE RICE LN
Mailing Address - Street 2:
Mailing Address - City:AMITY
Mailing Address - State:OR
Mailing Address - Zip Code:97101-2305
Mailing Address - Country:US
Mailing Address - Phone:503-835-0416
Mailing Address - Fax:
Practice Address - Street 1:201 NE PARK PLAZA DR
Practice Address - Street 2:SUITE 246
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-5808
Practice Address - Country:US
Practice Address - Phone:800-336-6862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR983121225X00000X
WAOT00002552225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist