Provider Demographics
NPI:1457663700
Name:HARMON, ROSANNA GRACE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ROSANNA
Middle Name:GRACE
Last Name:HARMON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:915 E 5TH ST
Mailing Address - Street 2:ST CLARES HOSPITAL OUTPATIENT DEPARTMENT
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-6434
Mailing Address - Country:US
Mailing Address - Phone:618-463-5171
Mailing Address - Fax:618-463-5175
Practice Address - Street 1:915 E 5TH ST
Practice Address - Street 2:ST CLARES HOSPITAL OUTPATIENT DEPARTMENT
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-6434
Practice Address - Country:US
Practice Address - Phone:618-463-5171
Practice Address - Fax:618-463-5175
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.004404225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist