Basic Information
| Provider Information | |||||||||
| NPI: | 1013156090 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROTHER | ||||||||
| FirstName: | MARY ANN | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1086 STATE ROUTE 315 PLAZA | ||||||||
| Address2: | |||||||||
| City: | PLAINS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5708237761 | ||||||||
| FaxNumber: | 5708297761 | ||||||||
| Practice Location | |||||||||
| Address1: | 106 ROTARY DR | ||||||||
| Address2: | |||||||||
| City: | WEST HAZLETON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 182021182 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5704596333 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2009 | ||||||||
| LastUpdateDate: | 02/13/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OC006315L | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.