Provider Demographics
NPI:1578679114
Name:ROSAL, JEANNE CAROL (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:JEANNE
Middle Name:CAROL
Last Name:ROSAL
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:PO BOX 2163
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27836-0163
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:102 EASTBROOK DR
Practice Address - Street 2:SUITE C
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-4211
Practice Address - Country:US
Practice Address - Phone:252-830-0245
Practice Address - Fax:252-830-0247
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1693225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC139PCOtherBLUECROSS BLUESHIELD
NC7301812Medicaid
NCE2959OtherMEDCOST PROVIDER NUMBER