Provider Demographics
NPI:1679834543
Name:MABUS, ROSALYN ANN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ROSALYN
Middle Name:ANN
Last Name:MABUS
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 1:17350 OLD TURNPIKE RD
Mailing Address - Street 2:
Mailing Address - City:MILLMONT
Mailing Address - State:PA
Mailing Address - Zip Code:17845-9334
Mailing Address - Country:US
Mailing Address - Phone:570-922-3351
Mailing Address - Fax:
Practice Address - Street 1:17350 OLD TURNPIKE RD
Practice Address - Street 2:
Practice Address - City:MILLMONT
Practice Address - State:PA
Practice Address - Zip Code:17845-9334
Practice Address - Country:US
Practice Address - Phone:570-922-3351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC001813L314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility