Provider Demographics
NPI:1417481391
Name:ROSADO, AIDEE (MOT, OTR/L, MPH)
Entity type:Individual
Prefix:
First Name:AIDEE
Middle Name:
Last Name:ROSADO
Suffix:
Gender:F
Credentials:MOT, OTR/L, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16815 S DESERT FOOTHILLS PKWY
Mailing Address - Street 2:SUITE 126
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-8401
Mailing Address - Country:US
Mailing Address - Phone:480-704-5954
Mailing Address - Fax:
Practice Address - Street 1:16815 S DESERT FOOTHILLS PKWY
Practice Address - Street 2:SUITE 126
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-8401
Practice Address - Country:US
Practice Address - Phone:480-704-5954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-17
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6164225X00000X
TX116442225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist