Provider Demographics
NPI:1881136273
Name:ROSE, MICHELLE RANAE (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:RANAE
Last Name:ROSE
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 RUBY VISTA DR UNIT 102
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-2876
Mailing Address - Country:US
Mailing Address - Phone:775-753-1214
Mailing Address - Fax:
Practice Address - Street 1:1020 RUBY VISTA DR UNIT 102
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-2876
Practice Address - Country:US
Practice Address - Phone:775-753-1214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-16
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV17-0875225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist