Provider Demographics
NPI:1093944480
Name:CARR, ROSEANN E
Entity Type:Individual
Prefix:
First Name:ROSEANN
Middle Name:E
Last Name:CARR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:S11110 STATE ROAD 93
Mailing Address - Street 2:
Mailing Address - City:ELEVA
Mailing Address - State:WI
Mailing Address - Zip Code:54738-4131
Mailing Address - Country:US
Mailing Address - Phone:715-878-9049
Mailing Address - Fax:
Practice Address - Street 1:S11110 STATE ROAD 93
Practice Address - Street 2:
Practice Address - City:ELEVA
Practice Address - State:WI
Practice Address - Zip Code:54738-4131
Practice Address - Country:US
Practice Address - Phone:715-878-9049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist