Provider Demographics
NPI:1053496570
Name:RYALS, ROSELLEN BECKER (OTR)
Entity Type:Individual
Prefix:MRS
First Name:ROSELLEN
Middle Name:BECKER
Last Name:RYALS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:ROSELLEN
Other - Middle Name:MARIE
Other - Last Name:RYALS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR
Mailing Address - Street 1:204 LEE CARTER DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-3096
Mailing Address - Country:US
Mailing Address - Phone:423-282-0827
Mailing Address - Fax:423-722-2063
Practice Address - Street 1:401 E MAIN ST SUITE 5
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601
Practice Address - Country:US
Practice Address - Phone:423-722-2062
Practice Address - Fax:423-722-2063
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOT0000003409225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist