Healthcare Provider Details

I. General information

NPI: 1457289944
Provider Name (Legal Business Name): CARRIE ROTH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 N SALES ST
MERRILL WI
54452-3198
US

IV. Provider business mailing address

814 AR VI LN APT SUITE
ANTIGO WI
54409-9572
US

V. Phone/Fax

Practice location:
  • Phone: 715-536-5233
  • Fax:
Mailing address:
  • Phone: 715-216-5901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: