Basic Information
| Provider Information | |||||||||
| NPI: | 1538832761 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ROTH | ||||||||
| FirstName: | HUNTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25 N 9TH STREET | ||||||||
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| City: | EMMAUS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4846788638 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 KIRKLAND VILLAGE CIRCLE | ||||||||
| Address2: | |||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106914500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2021 | ||||||||
| LastUpdateDate: | 07/27/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | PA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225X00000X | OC017782 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.