Provider Demographics
NPI:1326379991
Name:ROTH, MARIA JANEL LEE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:MARIA JANEL
Middle Name:LEE
Last Name:ROTH
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6011 SE TOWER DR
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-7615
Mailing Address - Country:US
Mailing Address - Phone:772-286-7895
Mailing Address - Fax:
Practice Address - Street 1:6011 SE TOWER DR
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-7615
Practice Address - Country:US
Practice Address - Phone:772-286-7895
Practice Address - Fax:772-286-7894
Is Sole Proprietor?:No
Enumeration Date:2010-01-21
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 5362225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist