Individual
JOHN ROACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
170 KIMEL PARK DR, WINSTON SALEM, NC 27103-6946
(336) 768-1270
Mailing address
1428 RIVER ROCK PL APT 104, MEMPHIS, TN 38103-6991
(870) 919-7264
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
17770
NC
225X00000X
Occupational Therapist
Primary
17986
NC
Other
Enumeration date
07/08/2025
Last updated
09/15/2025
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