Provider Demographics
NPI:1417224247
Name:COLEMAN, ROSANNE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ROSANNE
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 CHESTER ST
Mailing Address - Street 2:
Mailing Address - City:LAKE GROVE
Mailing Address - State:NY
Mailing Address - Zip Code:11755-3048
Mailing Address - Country:US
Mailing Address - Phone:631-588-9710
Mailing Address - Fax:
Practice Address - Street 1:35 CARMAN RD
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-5651
Practice Address - Country:US
Practice Address - Phone:631-549-5580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001749-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist