Healthcare Provider Details

I. General information

NPI: 1346171840
Provider Name (Legal Business Name): ANNE ROQUET OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11962 WOODSIDE AVE
LAKESIDE CA
92040-2914
US

IV. Provider business mailing address

4036 SHASTA ST
SAN DIEGO CA
92109-6040
US

V. Phone/Fax

Practice location:
  • Phone: 619-561-1222
  • Fax:
Mailing address:
  • Phone: 951-836-2024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number27344
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: