Provider Demographics
NPI:1689319048
Name:ROSA, REBEKKAH NICOLE
Entity Type:Individual
Prefix:
First Name:REBEKKAH
Middle Name:NICOLE
Last Name:ROSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 ASHFORD OAKS DR APT 201
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-5571
Mailing Address - Country:US
Mailing Address - Phone:954-918-3693
Mailing Address - Fax:
Practice Address - Street 1:111 E LAKE MARY BLVD STE 113
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32773-7111
Practice Address - Country:US
Practice Address - Phone:407-203-9492
Practice Address - Fax:321-332-9768
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-30
Last Update Date:2023-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL469867224Z00000X
FL18848224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant