Provider Demographics
NPI:1265203624
Name:ROUSSE, VANESSA
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:ROUSSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 DELAWARE VETERANS BLVD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-5395
Mailing Address - Country:US
Mailing Address - Phone:347-248-1566
Mailing Address - Fax:
Practice Address - Street 1:100 DELAWARE VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-5395
Practice Address - Country:US
Practice Address - Phone:302-424-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEU2-0001669224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant