Individual
HEATHER ROESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTD, OTR/L
Contact information
Practice address
118 E BLAINE ST, RIVERSIDE, CA 92507-3226
(951) 990-3115
Mailing address
PO BOX 53278, RIVERSIDE, CA 92517-4278
(951) 990-3115
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT 11998
—
225XP0200X
Pediatric Occupational Therapist
11998
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OT 11998
OT LICENSE
CA
Enumeration date
08/28/2012
Last updated
02/10/2023
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