Provider Demographics
NPI:1477230043
Name:ROYSTER, ROCHELE (ATR-BC)
Entity Type:Individual
Prefix:
First Name:ROCHELE
Middle Name:
Last Name:ROYSTER
Suffix:
Gender:F
Credentials:ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 VANIDA LN
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-1532
Mailing Address - Country:US
Mailing Address - Phone:312-545-3127
Mailing Address - Fax:
Practice Address - Street 1:103 VANIDA LN
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-1532
Practice Address - Country:US
Practice Address - Phone:312-545-3127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY19-512221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist