Provider Demographics
NPI:1144808759
Name:ROSENCRANS, KARLY RAE
Entity type:Individual
Prefix:
First Name:KARLY
Middle Name:RAE
Last Name:ROSENCRANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1548 OTTAWA AVE
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-3418
Mailing Address - Country:US
Mailing Address - Phone:815-993-4955
Mailing Address - Fax:
Practice Address - Street 1:516 W FRENCH STREET
Practice Address - Street 2:
Practice Address - City:STREATOR
Practice Address - State:IL
Practice Address - Zip Code:61364
Practice Address - Country:US
Practice Address - Phone:815-672-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057005188224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant