Provider Demographics
NPI:1144369208
Name:ROE, SALLIE ROXANNE (OTRL)
Entity type:Individual
Prefix:MRS
First Name:SALLIE
Middle Name:ROXANNE
Last Name:ROE
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:MISS
Other - First Name:SALLIE
Other - Middle Name:ROXANNE
Other - Last Name:EWALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:11313 NASSAU DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-2656
Mailing Address - Country:US
Mailing Address - Phone:505-294-0134
Mailing Address - Fax:
Practice Address - Street 1:4308 CARLISLE BLVD NE
Practice Address - Street 2:SUITE 209
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-4856
Practice Address - Country:US
Practice Address - Phone:505-828-0232
Practice Address - Fax:505-823-1051
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM446225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist