Provider Demographics
NPI:1285190496
Name:ROSENBAUM, KATHLEEN GRACE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:GRACE
Last Name:ROSENBAUM
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 1:165 JOHNSON CIR
Mailing Address - Street 2:
Mailing Address - City:LOCKESBURG
Mailing Address - State:AR
Mailing Address - Zip Code:71846-9032
Mailing Address - Country:US
Mailing Address - Phone:870-557-6102
Mailing Address - Fax:
Practice Address - Street 1:165 JOHNSON CIR
Practice Address - Street 2:
Practice Address - City:LOCKESBURG
Practice Address - State:AR
Practice Address - Zip Code:71846-9032
Practice Address - Country:US
Practice Address - Phone:870-557-6102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-12
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX215592225XP0200X, 224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics