Provider Demographics
NPI:1295207439
Name:ROOSS, EMMA
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:ROOSS
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 1:190 N MIDDAUGH ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-1404
Mailing Address - Country:US
Mailing Address - Phone:908-566-7291
Mailing Address - Fax:
Practice Address - Street 1:190 N MIDDAUGH ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-1404
Practice Address - Country:US
Practice Address - Phone:908-566-7291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-28
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10900329-4201225X00000X
COOT.0005550225X00000X
OR379938225X00000X
MEOT3508225X00000X
NJ46TR00784500225X00000X
CA19200225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist