Provider Demographics
NPI:1134851660
Name:OJO, ROSE MIREILLE
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:MIREILLE
Last Name:OJO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ROSE-MIREILLE
Other - Middle Name:
Other - Last Name:LOUIS-PIERRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1022 INDIAN TRACE CIR APT 104
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-1156
Mailing Address - Country:US
Mailing Address - Phone:386-262-5804
Mailing Address - Fax:
Practice Address - Street 1:1022 INDIAN TRACE CIR APT 104
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-1156
Practice Address - Country:US
Practice Address - Phone:386-262-5804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-24
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA80358225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
24975138OtherN/A