Provider Demographics
NPI:1881324424
Name:CAIN, ROSANNA (COTA)
Entity type:Individual
Prefix:
First Name:ROSANNA
Middle Name:
Last Name:CAIN
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 1:1201 E SCIOTA AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:61616-6349
Mailing Address - Country:US
Mailing Address - Phone:309-643-3910
Mailing Address - Fax:
Practice Address - Street 1:1201 E SCIOTA AVE
Practice Address - Street 2:
Practice Address - City:PEORIA HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:61616-6349
Practice Address - Country:US
Practice Address - Phone:309-643-3910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty