Provider Demographics
NPI:1518149210
Name:ROSE, WHITNEY RENEE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:WHITNEY
Middle Name:RENEE
Last Name:ROSE
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 1:1600 RIVERFRONT DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202
Mailing Address - Country:US
Mailing Address - Phone:501-663-6965
Mailing Address - Fax:
Practice Address - Street 1:3419 N PLAINVIEW AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4065
Practice Address - Country:US
Practice Address - Phone:479-521-4001
Practice Address - Fax:479-521-1621
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR2160225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist