Provider Demographics
NPI:1780151993
Name:ROSSER, TAYLOR BROOKE (COTA)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:BROOKE
Last Name:ROSSER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 GUN AND ROD CLUB RD
Mailing Address - Street 2:
Mailing Address - City:HARRINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19952-2028
Mailing Address - Country:US
Mailing Address - Phone:302-233-3890
Mailing Address - Fax:
Practice Address - Street 1:191 WESTMINSTER DR
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-8717
Practice Address - Country:US
Practice Address - Phone:302-744-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant