Individual
CAROLE M ROESKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
6040 LUTE RD, PORTAGE, IN 46368-5008
(219) 763-6858
(219) 763-4858
Mailing address
492 S 500 W, VALPARAISO, IN 46385-9637
(219) 988-2024
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
32000686A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
32000686A
COTA
IN
Enumeration date
07/12/2007
Last updated
07/12/2007
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