Provider Demographics
NPI:1760802441
Name:ROTH, CHRISTINE LEAH (OT)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:LEAH
Last Name:ROTH
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MISS
Other - First Name:CHRISTINE
Other - Middle Name:LEAH
Other - Last Name:GARBARINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:233 INCHON RD
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:VA
Mailing Address - Zip Code:23801-1464
Mailing Address - Country:US
Mailing Address - Phone:603-321-2553
Mailing Address - Fax:
Practice Address - Street 1:201 EPPES ST
Practice Address - Street 2:
Practice Address - City:HOPEWELL
Practice Address - State:VA
Practice Address - Zip Code:23860-2717
Practice Address - Country:US
Practice Address - Phone:804-541-1445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-22
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119007188225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist