Individual
WADE ROACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
888 N MAIN ST, 5085876566, BROCKTON, MA 02301-1668
(508) 587-6566
Mailing address
888 N MAIN ST, 5085876566, BROCKTON, MA 02301-1668
(508) 587-6566
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
3996
MA
Other
Enumeration date
10/06/2015
Last updated
10/06/2015
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