Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 299 | NE |
NPI | 1639303753 |
---|---|
Provider Name | Virginia Rotolo |
First Address | Omaha, NE 68105-2512 |
Second Address | Syracuse, NE 68446-7017 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2009 |
Last Update Date | 04/05/2009 |