Provider Demographics
NPI:1902047780
Name:DEGREZIA, ROSANNA (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ROSANNA
Middle Name:
Last Name:DEGREZIA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:ROSANNA
Other - Middle Name:
Other - Last Name:BUMBALO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:8010 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-3118
Mailing Address - Country:US
Mailing Address - Phone:718-757-6191
Mailing Address - Fax:
Practice Address - Street 1:8010 15TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-3118
Practice Address - Country:US
Practice Address - Phone:718-757-6191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-09
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014185225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist