Provider Demographics
NPI:1316151681
Name:ROSALIN, LIZA (OT)
Entity type:Individual
Prefix:
First Name:LIZA
Middle Name:
Last Name:ROSALIN
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 1:2863 BIG DIPPER LN
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-7063
Mailing Address - Country:US
Mailing Address - Phone:616-510-0581
Mailing Address - Fax:
Practice Address - Street 1:1628 JOHN F KENNEDY BLVD
Practice Address - Street 2:SUITE 401
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-2125
Practice Address - Country:US
Practice Address - Phone:215-557-0057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC010080225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist