Healthcare Provider Details

I. General information

NPI: 1538670351
Provider Name (Legal Business Name): CHRISTA KATHLEEN ROISMAN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2017
Last Update Date: 10/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 UNION ST
WELLINGTON OH
44090-1072
US

IV. Provider business mailing address

36166 N PARK DR
AVON OH
44011-3441
US

V. Phone/Fax

Practice location:
  • Phone: 440-647-3636
  • Fax: 440-647-1089
Mailing address:
  • Phone: 440-610-0946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT005279
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: