Provider Demographics
NPI:1174667539
Name:HALBACK, ROSEANN (OTR/L)
Entity Type:Individual
Prefix:
First Name:ROSEANN
Middle Name:
Last Name:HALBACK
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 1:12000 4TH ST N
Mailing Address - Street 2:APT. 177
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-1708
Mailing Address - Country:US
Mailing Address - Phone:352-318-1379
Mailing Address - Fax:
Practice Address - Street 1:500 7TH AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4820
Practice Address - Country:US
Practice Address - Phone:727-767-3843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2008-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTT 12633225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics