Provider Demographics
NPI:1417151275
Name:ROUX, DENISE LOUISE
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:LOUISE
Last Name:ROUX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1687
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20849-1687
Mailing Address - Country:US
Mailing Address - Phone:301-649-7170
Mailing Address - Fax:301-260-8487
Practice Address - Street 1:110 N WASHINGTON ST
Practice Address - Street 2:SUITE 205
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-2223
Practice Address - Country:US
Practice Address - Phone:301-649-7170
Practice Address - Fax:301-260-8487
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCOT408225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist