Healthcare Provider Details

I. General information

NPI: 1427678473
Provider Name (Legal Business Name): MARGUERITE KATHHLEEN ROQUE OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2020
Last Update Date: 04/20/2020
Certification Date: 04/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CLOCKTOWER RIDGE DR
WINCHESTER VA
22603-3878
US

IV. Provider business mailing address

501 CHESTNUT LN
BERRYVILLE VA
22611-2951
US

V. Phone/Fax

Practice location:
  • Phone: 540-431-2800
  • Fax:
Mailing address:
  • Phone: 540-514-8010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119008512
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: