Provider Demographics
NPI:1659943009
Name:LUNCASU-ROLEA, ROSE JAEL (OTR)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:JAEL
Last Name:LUNCASU-ROLEA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1626 172ND AVE NE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98008-2916
Mailing Address - Country:US
Mailing Address - Phone:919-972-9257
Mailing Address - Fax:
Practice Address - Street 1:1301 4TH AVE NW STE 100
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-9371
Practice Address - Country:US
Practice Address - Phone:425-392-7989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT61152118225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA61152118OtherWASHINGTON STATE DOH