Provider Demographics
NPI:1548715121
Name:GOLDROSEN, ALEEZA (OTR/L)
Entity type:Individual
Prefix:
First Name:ALEEZA
Middle Name:
Last Name:GOLDROSEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14934 SCHAEFFER RD
Mailing Address - Street 2:
Mailing Address - City:BOYDS
Mailing Address - State:MD
Mailing Address - Zip Code:20841-8940
Mailing Address - Country:US
Mailing Address - Phone:301-260-1111
Mailing Address - Fax:
Practice Address - Street 1:4860 S PALMER RD
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-5649
Practice Address - Country:US
Practice Address - Phone:301-319-3797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-24
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCOTA100000289224Z00000X
MDA02169224Z00000X
MD08867225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant