Provider Demographics
NPI:1710256078
Name:ROLLER, KACI J (OTR)
Entity Type:Individual
Prefix:MRS
First Name:KACI
Middle Name:J
Last Name:ROLLER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:KACI
Other - Middle Name:J
Other - Last Name:SOLTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:10757 W ROSTED RD
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49651-8203
Mailing Address - Country:US
Mailing Address - Phone:231-779-2908
Mailing Address - Fax:
Practice Address - Street 1:10757 W ROSTED RD
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:MI
Practice Address - Zip Code:49651-8203
Practice Address - Country:US
Practice Address - Phone:231-779-2908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-15
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201003324225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist