Provider Demographics
NPI:1144426057
Name:ROACH, NANCY JOANNE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:JOANNE
Last Name:ROACH
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7086 SANDALVIEW DR
Mailing Address - Street 2:
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-2571
Mailing Address - Country:US
Mailing Address - Phone:937-233-4625
Mailing Address - Fax:937-496-1990
Practice Address - Street 1:320 ALBANY ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45408-1402
Practice Address - Country:US
Practice Address - Phone:937-496-6200
Practice Address - Fax:937-496-1990
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA-03014224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant