Healthcare Provider Details

I. General information

NPI: 1275285009
Provider Name (Legal Business Name): ANN-MARIE OLANSEN ROTH OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANN OLANSEN ROTH

II. Dates (important events)

Enumeration Date: 01/24/2022
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

863 N MAIN ST EXT STE 200
WALLINGFORD CT
06492-4999
US

IV. Provider business mailing address

863 N MAIN ST EXT STE 200
WALLINGFORD CT
06492-4999
US

V. Phone/Fax

Practice location:
  • Phone: 203-265-3280
  • Fax: 203-741-6569
Mailing address:
  • Phone: 203-265-3280
  • Fax: 203-741-6569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number001094
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: