Provider Demographics
NPI:1912239435
Name:WISNIEWSKI, ROSEMARY KENNEDY (OTR)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:KENNEDY
Last Name:WISNIEWSKI
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 1:12863 WINDSOR CT
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-4176
Mailing Address - Country:US
Mailing Address - Phone:586-731-7816
Mailing Address - Fax:
Practice Address - Street 1:51850 DEQUINDRE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48316-2806
Practice Address - Country:US
Practice Address - Phone:586-991-0801
Practice Address - Fax:586-991-0804
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-09
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201002230225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist