Provider Demographics
NPI:1790838647
Name:ROSARIO, ILEANA CELESTE (OTR, CHT)
Entity Type:Individual
Prefix:
First Name:ILEANA
Middle Name:CELESTE
Last Name:ROSARIO
Suffix:
Gender:F
Credentials:OTR, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9227 PEBBLE CREEK DRIVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2455
Mailing Address - Country:US
Mailing Address - Phone:813-994-2583
Mailing Address - Fax:
Practice Address - Street 1:13000 BRUCE B. DOWNS BLVD.
Practice Address - Street 2:JAMES A. HALEY VA HOSPITAL
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612
Practice Address - Country:US
Practice Address - Phone:813-972-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 13017225XH1200X
FLOT13017225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand