Provider Demographics
NPI:1760760508
Name:ROSALEZ, MONIQUE DEANN (COTA)
Entity Type:Individual
Prefix:MRS
First Name:MONIQUE
Middle Name:DEANN
Last Name:ROSALEZ
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64130-2035
Mailing Address - Country:US
Mailing Address - Phone:816-838-4894
Mailing Address - Fax:
Practice Address - Street 1:4401 INDIANA AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64130-2035
Practice Address - Country:US
Practice Address - Phone:816-838-4894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-27
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST-03078224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant