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General NPI Number Information
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NPI Number | 1356523955
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Entity Type | Individual
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Provider Name | MRS. TARI ROTH
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Gender | Female
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Dates
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Enumeration Date | 12/05/2007
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Last Update Date | 12/05/2007
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Provider Practice Location Address
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Address Line | 30101 TOWN CENTER DR STE 216
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92677-2065
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Country | US
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Telephone | 949-683-5264
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Fax |
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Provider Business Mailing Address
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Address Line | 31562 SEA SHADOWS WAY
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92677-5410
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Country | US
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Telephone | 949-499-6511
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 6939
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License Number State | CA
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