Provider Demographics
NPI:1689770737
Name:ROSE, DAVID WAYNE (OTR L)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:WAYNE
Last Name:ROSE
Suffix:
Gender:M
Credentials:OTR L
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7 HUNTING HILL LN
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72227-3824
Mailing Address - Country:US
Mailing Address - Phone:501-257-6489
Mailing Address - Fax:501-257-6419
Practice Address - Street 1:4300 W 7TH ST
Practice Address - Street 2:PMRS 117
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5446
Practice Address - Country:US
Practice Address - Phone:501-257-6489
Practice Address - Fax:501-257-6419
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AROTR670225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist