Provider Demographics
NPI:1558656249
Name:WELBERG, ROCHELLE MARY (COTA/L)
Entity Type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:MARY
Last Name:WELBERG
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 VISTA DR
Mailing Address - Street 2:
Mailing Address - City:MILBANK
Mailing Address - State:SD
Mailing Address - Zip Code:57252-3207
Mailing Address - Country:US
Mailing Address - Phone:605-432-4556
Mailing Address - Fax:
Practice Address - Street 1:1103 S 2ND ST
Practice Address - Street 2:
Practice Address - City:MILBANK
Practice Address - State:SD
Practice Address - Zip Code:57252-3304
Practice Address - Country:US
Practice Address - Phone:605-432-4556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD228A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant