Provider Demographics
NPI:1346400884
Name:PETTY, ROSALYN JUNE (OTR L)
Entity Type:Individual
Prefix:MRS
First Name:ROSALYN
Middle Name:JUNE
Last Name:PETTY
Suffix:
Gender:F
Credentials:OTR L
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Mailing Address - Street 1:11301 WILSHIRE BLVD
Mailing Address - Street 2:W117 VA GREATER LA HEALTHCARE SYSTEM
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90073
Mailing Address - Country:US
Mailing Address - Phone:310-478-3711
Mailing Address - Fax:310-268-4935
Practice Address - Street 1:11301 WILSHIRE BLVD
Practice Address - Street 2:W117 DEPARTMENT OF VETERANS AFFAIRS
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90073
Practice Address - Country:US
Practice Address - Phone:310-478-3711
Practice Address - Fax:310-268-4935
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAOT 1259225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist