Provider Demographics
NPI:1639379704
Name:ROSANIA, BRENDA SUE
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:SUE
Last Name:ROSANIA
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 1:116 CHURCH ST
Mailing Address - Street 2:APT.#5
Mailing Address - City:CATASAUQUA
Mailing Address - State:PA
Mailing Address - Zip Code:18032-2558
Mailing Address - Country:US
Mailing Address - Phone:610-264-8444
Mailing Address - Fax:
Practice Address - Street 1:7650 ROUTE 309
Practice Address - Street 2:
Practice Address - City:COOPERSBURG
Practice Address - State:PA
Practice Address - Zip Code:18036-2130
Practice Address - Country:US
Practice Address - Phone:610-282-1919
Practice Address - Fax:610-282-6157
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP006033224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant