Provider Demographics
NPI:1821628546
Name:ROSENTHAL, CARLY DANA (OTR/L)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:DANA
Last Name:ROSENTHAL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 SPRUCE ST APT 7A
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-6043
Mailing Address - Country:US
Mailing Address - Phone:443-745-9484
Mailing Address - Fax:
Practice Address - Street 1:1122 SPRUCE ST APT 7A
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-6043
Practice Address - Country:US
Practice Address - Phone:443-745-9484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC016682225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty