MEDICARE: STACI M ROTH OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	056013526	IL

General Provider Information

NPI Number	:	1285609420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACI M ROTH OTR

Provider Business Mailing Address
First Line	:	38W125 HENRICKSEN RD
Second Line	:
City	:	SAINT CHARLES
State	:	IL
Zip	:	60175-5471
Country	:	US
Telephone Number	:	630-217-0834
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 E MAIN ST STE G
Second Line	:
City	:	SAINT CHARLES
State	:	IL
Zip	:	60174-2431
Country	:	US
Telephone Number	:	630-880-0993
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	06/12/2026

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Directions to “ STACI M ROTH OTR” Practice Location

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