Provider Demographics
NPI:1891910121
Name:ROODMAN, CAROL (OT)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:ROODMAN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:118 W JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-4008
Mailing Address - Country:US
Mailing Address - Phone:314-582-8874
Mailing Address - Fax:
Practice Address - Street 1:118 W JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-4008
Practice Address - Country:US
Practice Address - Phone:314-582-8874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO004799OtherLICENSE#