Provider Demographics
NPI:1427500230
Name:ROOS, ELEANOR GALIT (MOT, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:ELEANOR
Middle Name:GALIT
Last Name:ROOS
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:MISS
Other - First Name:ELEANOR
Other - Middle Name:MAE
Other - Last Name:GALIT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT, OTR/L
Mailing Address - Street 1:812 S GARFIELD AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-3456
Mailing Address - Country:US
Mailing Address - Phone:231-421-9201
Mailing Address - Fax:
Practice Address - Street 1:812 S GARFIELD AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-3456
Practice Address - Country:US
Practice Address - Phone:231-421-9201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201009660225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5201009660OtherSTATE OCCUPATIONAL THERAPY LICENSE