Provider Demographics
NPI:1063719177
Name:ROSENBERG, WHITNEY E (OT)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:E
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 OLIVER RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-3424
Mailing Address - Country:US
Mailing Address - Phone:707-428-1311
Mailing Address - Fax:707-428-1354
Practice Address - Street 1:1411 OLIVER RD
Practice Address - Street 2:SUITE 200
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-3424
Practice Address - Country:US
Practice Address - Phone:707-428-1311
Practice Address - Fax:707-428-1354
Is Sole Proprietor?:No
Enumeration Date:2011-02-25
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT14048225X00000X
FLOT14553225X00000X
MSOT2663225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist