Provider Demographics
NPI:1316356918
Name:MILLER ROCHE, CHERON DARLENE (OT/L)
Entity Type:Individual
Prefix:
First Name:CHERON
Middle Name:DARLENE
Last Name:MILLER ROCHE
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:CHERON
Other - Middle Name:DARLENE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OT/L
Mailing Address - Street 1:333 ELMWOOD AVE
Mailing Address - Street 2:GENESIS REHAB SERVICES
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-2491
Mailing Address - Country:US
Mailing Address - Phone:973-313-2104
Mailing Address - Fax:
Practice Address - Street 1:333 ELMWOOD AVE
Practice Address - Street 2:GENESIS REHAB SERVICES
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-2491
Practice Address - Country:US
Practice Address - Phone:973-313-2104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00075100225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist