Provider Demographics
NPI:1689702771
Name:ROSA, TANIA CARMELA (OTR)
Entity Type:Individual
Prefix:MS
First Name:TANIA
Middle Name:CARMELA
Last Name:ROSA
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 1:76 SOPHIA ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02909-5332
Mailing Address - Country:US
Mailing Address - Phone:401-996-1294
Mailing Address - Fax:
Practice Address - Street 1:42 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02907-1716
Practice Address - Country:US
Practice Address - Phone:401-277-2600
Practice Address - Fax:401-277-2603
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIOT01091225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist