Provider Demographics
NPI:1356657506
Name:LARDIZABAL, ROSE MARIE CASTILLO (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:ROSE MARIE
Middle Name:CASTILLO
Last Name:LARDIZABAL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
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Mailing Address - Street 1:5809 32ND AVE
Mailing Address - Street 2:APT# 1
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-2017
Mailing Address - Country:US
Mailing Address - Phone:718-440-9639
Mailing Address - Fax:718-440-9639
Practice Address - Street 1:5809 32ND AVE
Practice Address - Street 2:APT# 1
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-2017
Practice Address - Country:US
Practice Address - Phone:718-440-9639
Practice Address - Fax:718-440-9639
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY012138-1225X00000X
FL0007929225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist