Provider Demographics
NPI:1316192776
Name:ROTH, RHONDA LYNN (MOT, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:RHONDA
Middle Name:LYNN
Last Name:ROTH
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:MS
Other - First Name:RHONDA
Other - Middle Name:LYNN
Other - Last Name:MERRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOTR, OTR/L
Mailing Address - Street 1:7756 S BISCAYNE DR
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD HEIGHTS
Mailing Address - State:UT
Mailing Address - Zip Code:84121-5310
Mailing Address - Country:US
Mailing Address - Phone:303-817-8939
Mailing Address - Fax:
Practice Address - Street 1:7756 S BISCAYNE DR
Practice Address - Street 2:
Practice Address - City:COTTONWOOD HEIGHTS
Practice Address - State:UT
Practice Address - Zip Code:84121-5310
Practice Address - Country:US
Practice Address - Phone:303-817-8939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-25
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOT-1301225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics