Provider Demographics
NPI:1720162407
Name:DAUS, ROSEMARY LEE (OTAL)
Entity Type:Individual
Prefix:MRS
First Name:ROSEMARY
Middle Name:LEE
Last Name:DAUS
Suffix:
Gender:F
Credentials:OTAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 S CLLINTON AVENUE
Mailing Address - Street 2:SUITE C
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28334
Mailing Address - Country:US
Mailing Address - Phone:910-892-0027
Mailing Address - Fax:910-892-0029
Practice Address - Street 1:1100 S CLLINTON AVENUE
Practice Address - Street 2:SUITE C
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334
Practice Address - Country:US
Practice Address - Phone:910-892-0027
Practice Address - Fax:910-892-0029
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4792225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7211639Medicaid
346639Medicare ID - Type Unspecified