Provider Demographics
NPI:1750471876
Name:ROZEMA, DONNA JACOBS (COTA)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:JACOBS
Last Name:ROZEMA
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:3526 BARNARD AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-2722
Mailing Address - Country:US
Mailing Address - Phone:269-385-2162
Mailing Address - Fax:
Practice Address - Street 1:145 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MI
Practice Address - Zip Code:49348-1701
Practice Address - Country:US
Practice Address - Phone:269-792-4410
Practice Address - Fax:269-792-4538
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5202004966224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant