Provider Demographics
NPI:1952569113
Name:ROSEN, JEANNINE MARIE (OTR/L)
Entity type:Individual
Prefix:
First Name:JEANNINE
Middle Name:MARIE
Last Name:ROSEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 BOLIN CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-4106
Mailing Address - Country:US
Mailing Address - Phone:703-946-9910
Mailing Address - Fax:
Practice Address - Street 1:5826 FAYETTEVILLE RD STE 201
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-8684
Practice Address - Country:US
Practice Address - Phone:919-140-8969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6681225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist