Provider Demographics
NPI:1376894295
Name:ENOMATE, ROSE JILLIAN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:JILLIAN
Last Name:ENOMATE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:ROSE
Other - Middle Name:JILLIAN
Other - Last Name:CARPENTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RKT
Mailing Address - Street 1:1237 OAKFIELD DR S
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-1953
Mailing Address - Country:US
Mailing Address - Phone:419-290-6717
Mailing Address - Fax:
Practice Address - Street 1:1060 EASTWIND DR
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-3331
Practice Address - Country:US
Practice Address - Phone:614-212-6766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-02
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1695226300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist