Provider Demographics
NPI:1154676385
Name:VAN ROOYEN, SUMMER JOY (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:SUMMER
Middle Name:JOY
Last Name:VAN ROOYEN
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 1:115 2ND AVE W
Mailing Address - Street 2:STE 50
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-5918
Mailing Address - Country:US
Mailing Address - Phone:701-774-7430
Mailing Address - Fax:
Practice Address - Street 1:115 2ND AVE W
Practice Address - Street 2:STE 50
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-5918
Practice Address - Country:US
Practice Address - Phone:701-774-7430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1163225X00000X
CO2112225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist