Provider Demographics
NPI:1386452704
Name:ROSE, KIRSTEN
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:376 HALLS POND RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH PARIS
Mailing Address - State:ME
Mailing Address - Zip Code:04281-6031
Mailing Address - Country:US
Mailing Address - Phone:207-520-8755
Mailing Address - Fax:
Practice Address - Street 1:11 MECHANIC FALLS RD STE 4
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:ME
Practice Address - Zip Code:04270-3147
Practice Address - Country:US
Practice Address - Phone:207-539-5128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT5165225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist