Provider Demographics
NPI:1629638945
Name:ROWANE, RUTHANNE ELISE (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:RUTHANNE
Middle Name:ELISE
Last Name:ROWANE
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 STOCKTON ST APT 147
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23224-4363
Mailing Address - Country:US
Mailing Address - Phone:703-403-2941
Mailing Address - Fax:
Practice Address - Street 1:6410 COURTS DR
Practice Address - Street 2:
Practice Address - City:PRINCE GEORGE
Practice Address - State:VA
Practice Address - Zip Code:23875-2562
Practice Address - Country:US
Practice Address - Phone:804-733-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119-008231225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist