Provider Demographics
NPI:1508870478
Name:CYRUS RUKUS, ROSLYN CLARISSA (MS, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ROSLYN
Middle Name:CLARISSA
Last Name:CYRUS RUKUS
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7510 CONTEE RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-9244
Mailing Address - Country:US
Mailing Address - Phone:301-725-4112
Mailing Address - Fax:301-725-0936
Practice Address - Street 1:7510 CONTEE RD
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-9244
Practice Address - Country:US
Practice Address - Phone:301-725-4112
Practice Address - Fax:301-725-0936
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05219174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist