Provider Demographics
NPI:1881649143
Name:ROTH, GRETCHEN OLGA (OTR/L CHT)
Entity Type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:OLGA
Last Name:ROTH
Suffix:
Gender:F
Credentials:OTR/L CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:608 PANCOAST LN
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-1244
Mailing Address - Country:US
Mailing Address - Phone:610-269-0689
Mailing Address - Fax:610-518-6970
Practice Address - Street 1:2400 MARYLAND RD
Practice Address - Street 2:SUITE 10
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-1700
Practice Address - Country:US
Practice Address - Phone:215-657-1115
Practice Address - Fax:215-657-1848
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC001010L225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand