| Doctor Name: | MR. GARY L ROTH |
| NPI Number: | 1124289640 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | OTR |
| License Number: | 0720000081 |
| Business Practice Address: | 143 Lakewood Dr Killington, VT - 057519476 |
| Business Phone Number: | 8027734943 |
| Business Fax Number: | |
| Mailing Address: | 143 Lakewood Dr, KILLINGTON |
| State: | VT |
| Postal Code: | 057519476 |
| Phone Number: | 8027734943 |
| Fax Number: | |
| NPI Enumeration Date: | 06/18/2008 |
| NPI Last Update Date: | 06/18/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225XN1300X |
| License Number: | 0720000081 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VT |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Occupational Therapist |
| Taxonomy Specialization: | Neurorehabilitation |
| Taxonomy Definition: | |