Individual
CRYSTAL ROACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
874 HALLEY RD., ROYSTON, GA 30662
(559) 741-6390
Mailing address
874 HALLEY RD., ROYSTON, GA 30662
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT006644
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003186278A
—
GA
05
—
003186278C
—
GA
Enumeration date
02/27/2017
Last updated
05/26/2021
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