Provider Demographics
NPI:1114505047
Name:ROLF, MAGGIE KATHRYN (COTA/L)
Entity Type:Individual
Prefix:
First Name:MAGGIE
Middle Name:KATHRYN
Last Name:ROLF
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3545 LAKE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-1058
Mailing Address - Country:US
Mailing Address - Phone:847-386-6560
Mailing Address - Fax:
Practice Address - Street 1:1315 S BELL AVE STE 108
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-7730
Practice Address - Country:US
Practice Address - Phone:515-337-0343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-31
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
1518478684OtherPRIVATE INSURANCE