Basic Information
| Provider Information | |||||||||
| NPI: | 1760802441 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROTH | ||||||||
| FirstName: | CHRISTINE | ||||||||
| MiddleName: | LEAH | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | O.T. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GARBARINO | ||||||||
| OtherFirstName: | CHRISTINE | ||||||||
| OtherMiddleName: | LEAH | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | O.T. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 233 INCHON RD | ||||||||
| Address2: | |||||||||
| City: | FORT LEE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 238011464 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6033212553 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 201 EPPES ST | ||||||||
| Address2: | |||||||||
| City: | HOPEWELL | ||||||||
| State: | VA | ||||||||
| PostalCode: | 238602717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8045411445 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2014 | ||||||||
| LastUpdateDate: | 04/26/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 0119007188 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.