Provider Demographics
NPI:1124374392
Name:ROTH, SHERI JUDITH (OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:SHERI
Middle Name:JUDITH
Last Name:ROTH
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 1:34 OLYMPIA LN
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-2843
Mailing Address - Country:US
Mailing Address - Phone:845-641-7656
Mailing Address - Fax:
Practice Address - Street 1:34 OLYMPIA LN
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-2843
Practice Address - Country:US
Practice Address - Phone:845-641-7656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017420-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics