Provider Demographics
NPI:1538624077
Name:TOOMBS, ROSALYN T (COTA/L)
Entity type:Individual
Prefix:
First Name:ROSALYN
Middle Name:T
Last Name:TOOMBS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2224 W WESTPORT RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-4243
Mailing Address - Country:US
Mailing Address - Phone:309-453-3886
Mailing Address - Fax:
Practice Address - Street 1:900 CENTENNIAL DR
Practice Address - Street 2:
Practice Address - City:EAST PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61611-4928
Practice Address - Country:US
Practice Address - Phone:309-699-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-08
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057001053224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant