Provider Demographics
NPI:1336368703
Name:SMITH, ROSA MARIE (BS OTR)
Entity Type:Individual
Prefix:MISS
First Name:ROSA
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:BS OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1336 E ELM ST
Mailing Address - Street 2:FRONT HOUSE
Mailing Address - City:GRIFFITH
Mailing Address - State:IN
Mailing Address - Zip Code:46319-2854
Mailing Address - Country:US
Mailing Address - Phone:219-923-1371
Mailing Address - Fax:219-513-8327
Practice Address - Street 1:2350 TAFT ST
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46404-3349
Practice Address - Country:US
Practice Address - Phone:219-977-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31004261A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist