| Doctor Name: | THERESA MAHER ROTH |
| NPI Number: | 1083636849 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA OTR L CHT |
| License Number: | 360412 |
| Business Practice Address: | 19365 Sw 65th Ave Ste 200 Tualatin, OR - 970629196 |
| Business Phone Number: | 5036925210 |
| Business Fax Number: | 5036928821 |
| Mailing Address: | 19365 Sw 65th Ave Ste 200, TUALATIN |
| State: | OR |
| Postal Code: | 970629196 |
| Phone Number: | 5036925210 |
| Fax Number: | 5036928821 |
| NPI Enumeration Date: | 07/24/2006 |
| NPI Last Update Date: | 12/20/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225XH1200X |
| License Number: | 360412 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Occupational Therapist |
| Taxonomy Specialization: | Hand |
| Taxonomy Definition: | |