Provider Demographics
NPI:1427108679
Name:ROSEN, MICHELLE LEANN (OTRL)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LEANN
Last Name:ROSEN
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-9248
Mailing Address - Country:US
Mailing Address - Phone:406-600-9584
Mailing Address - Fax:
Practice Address - Street 1:2135 CHARLOTTE ST
Practice Address - Street 2:SUITE 3
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-2739
Practice Address - Country:US
Practice Address - Phone:406-586-8030
Practice Address - Fax:406-586-8036
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT981225XN1300X
225XN1300X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
Not Answered225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics