Provider Demographics
NPI:1316502958
Name:FRIESS, ROSALIA (OTR/L)
Entity type:Individual
Prefix:
First Name:ROSALIA
Middle Name:
Last Name:FRIESS
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 1:125 CODDINGTON PL APT 4
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-6594
Mailing Address - Country:US
Mailing Address - Phone:330-853-4983
Mailing Address - Fax:
Practice Address - Street 1:147 LAFAYETTE STREET
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401
Practice Address - Country:US
Practice Address - Phone:724-430-4848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC013516225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist