Provider Demographics
NPI:1467728972
Name:ROTH, CYRELLE F (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:CYRELLE
Middle Name:F
Last Name:ROTH
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 1:120 W 231ST ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-5905
Mailing Address - Country:US
Mailing Address - Phone:718-601-2869
Mailing Address - Fax:718-601-2867
Practice Address - Street 1:120 W 231ST ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-5905
Practice Address - Country:US
Practice Address - Phone:718-601-2869
Practice Address - Fax:718-601-2867
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012152-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist