Provider Demographics
NPI:1437619590
Name:ROSALES, NORILEEN (OTR)
Entity Type:Individual
Prefix:
First Name:NORILEEN
Middle Name:
Last Name:ROSALES
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1114 MORVEN RD
Mailing Address - Street 2:
Mailing Address - City:WADESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28170-3130
Mailing Address - Country:US
Mailing Address - Phone:704-475-5634
Mailing Address - Fax:
Practice Address - Street 1:119 W WADE ST
Practice Address - Street 2:
Practice Address - City:WADESBORO
Practice Address - State:NC
Practice Address - Zip Code:28170-2136
Practice Address - Country:US
Practice Address - Phone:704-694-5992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-23
Last Update Date:2019-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6711225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist