Provider Demographics
NPI:1124400551
Name:ROTH, MICHELLE HILARY (MS, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:HILARY
Last Name:ROTH
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Gender:F
Credentials:MS, OTR/L
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Mailing Address - Street 1:120 COUNTY ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670
Mailing Address - Country:US
Mailing Address - Phone:201-894-5800
Mailing Address - Fax:201-894-5990
Practice Address - Street 1:120 COUNTY ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670
Practice Address - Country:US
Practice Address - Phone:201-894-5800
Practice Address - Fax:201-894-5990
Is Sole Proprietor?:No
Enumeration Date:2015-06-22
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ46TR00287900225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics