Provider Demographics
NPI:1780982959
Name:ROSENOW, BRITTANY DIANA (COTA)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:DIANA
Last Name:ROSENOW
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 1:425 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FREDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:14063-1451
Mailing Address - Country:US
Mailing Address - Phone:716-679-1581
Mailing Address - Fax:
Practice Address - Street 1:425 E MAIN ST
Practice Address - Street 2:
Practice Address - City:FREDONIA
Practice Address - State:NY
Practice Address - Zip Code:14063-1451
Practice Address - Country:US
Practice Address - Phone:716-679-1581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-11
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007647-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant