Provider Demographics
NPI:1932376860
Name:ROEN, TODD ROBERT
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:ROBERT
Last Name:ROEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3166
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-0556
Mailing Address - Country:US
Mailing Address - Phone:254-217-0284
Mailing Address - Fax:254-217-0284
Practice Address - Street 1:2126 E HIGHWAY 190
Practice Address - Street 2:SUITE 1
Practice Address - City:COPPERAS COVE
Practice Address - State:TX
Practice Address - Zip Code:76522-2589
Practice Address - Country:US
Practice Address - Phone:254-217-0284
Practice Address - Fax:254-393-0602
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208862224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant