Healthcare Provider Details

I. General information

NPI: 1154697761
Provider Name (Legal Business Name): JESSICA ROACH MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2012
Last Update Date: 09/21/2025
Certification Date: 09/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25279 STATE ST
SAEGERTOWN PA
16433-7425
US

IV. Provider business mailing address

25279 STATE ST
SAEGERTOWN PA
16433-7425
US

V. Phone/Fax

Practice location:
  • Phone: 410-404-1604
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC012133
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: