Provider Demographics
NPI:1114184199
Name:AHMED, ROSE STELLA (OTR L)
Entity type:Individual
Prefix:MRS
First Name:ROSE STELLA
Middle Name:
Last Name:AHMED
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 1:4035 CUYAMACA CIR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95742-7716
Mailing Address - Country:US
Mailing Address - Phone:916-273-3389
Mailing Address - Fax:
Practice Address - Street 1:2115 J ST
Practice Address - Street 2:210
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-4738
Practice Address - Country:US
Practice Address - Phone:916-444-0033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9980225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist