Provider Demographics
NPI:1447702030
Name:KIDD, ROSEMARY G (OTR/L)
Entity type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:G
Last Name:KIDD
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 1:109 CAREFREE LN
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-9667
Mailing Address - Country:US
Mailing Address - Phone:714-812-4242
Mailing Address - Fax:
Practice Address - Street 1:812 SHEPARD ST
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-4250
Practice Address - Country:US
Practice Address - Phone:252-726-6855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-29
Last Update Date:2016-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10456225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist