Provider Demographics
NPI:1720599319
Name:MEADOWS, ROSETTE MAY CRUZ (COTA/L)
Entity Type:Individual
Prefix:
First Name:ROSETTE MAY
Middle Name:CRUZ
Last Name:MEADOWS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:ROSETTE MAY
Other - Middle Name:CRUZ
Other - Last Name:DUMLAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16471 N 175TH DR
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85388-3119
Mailing Address - Country:US
Mailing Address - Phone:623-428-3510
Mailing Address - Fax:
Practice Address - Street 1:16471 N 175TH DR.
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85388-8538
Practice Address - Country:US
Practice Address - Phone:623-428-3510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-23
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD04516454224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant