Provider Demographics
NPI:1811373251
Name:ROSOSKO, JORDAN (MS, OTRL)
Entity Type:Individual
Prefix:MS
First Name:JORDAN
Middle Name:
Last Name:ROSOSKO
Suffix:
Gender:F
Credentials:MS, OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45281 SYCAMORE CT
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48317-4936
Mailing Address - Country:US
Mailing Address - Phone:586-747-9598
Mailing Address - Fax:
Practice Address - Street 1:31155 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-1566
Practice Address - Country:US
Practice Address - Phone:248-585-7010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-07
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIR220439465648247200000X
MI5201010361225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other