Provider Demographics
NPI:1669277547
Name:ROSE, KOBE (OTD)
Entity type:Individual
Prefix:
First Name:KOBE
Middle Name:
Last Name:ROSE
Suffix:
Gender:M
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16192 EASTERLING RD
Mailing Address - Street 2:
Mailing Address - City:PEA RIDGE
Mailing Address - State:AR
Mailing Address - Zip Code:72751-2013
Mailing Address - Country:US
Mailing Address - Phone:479-445-4133
Mailing Address - Fax:
Practice Address - Street 1:16192 EASTERLING RD
Practice Address - Street 2:
Practice Address - City:PEA RIDGE
Practice Address - State:AR
Practice Address - Zip Code:72751-2013
Practice Address - Country:US
Practice Address - Phone:479-445-4133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-15
Last Update Date:2025-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist