Provider Demographics
NPI:1083989818
Name:ROSA, KELLY ANN (OTR/L)
Entity Type:Individual
Prefix:
First Name:KELLY ANN
Middle Name:
Last Name:ROSA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 AVENUE L
Mailing Address - Street 2:THE GIL HODGES SCHOOL
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-4546
Mailing Address - Country:US
Mailing Address - Phone:718-338-9011
Mailing Address - Fax:718-338-9074
Practice Address - Street 1:2515 AVENUE L
Practice Address - Street 2:THE GIL HODGES SCHOOL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-4546
Practice Address - Country:US
Practice Address - Phone:718-338-9011
Practice Address - Fax:718-338-9074
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014404-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist