Provider Demographics
NPI:1881898286
Name:WILD, ROSANNE (OTR)
Entity type:Individual
Prefix:
First Name:ROSANNE
Middle Name:
Last Name:WILD
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SAWYER ST
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-3739
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:769 S MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-5166
Practice Address - Country:US
Practice Address - Phone:603-641-6700
Practice Address - Fax:603-623-3611
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0468225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist