Provider Demographics
NPI:1306229679
Name:LOOMIS ROSTAN, DANIELE (MS OT)
Entity Type:Individual
Prefix:
First Name:DANIELE
Middle Name:
Last Name:LOOMIS ROSTAN
Suffix:
Gender:F
Credentials:MS OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 ASHLEY DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-3326
Mailing Address - Country:US
Mailing Address - Phone:585-200-0007
Mailing Address - Fax:
Practice Address - Street 1:114 ASHLEY DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-3326
Practice Address - Country:US
Practice Address - Phone:585-200-0007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-06
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY63P97520225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist