Individual
MISS COREY SUMMERLIN ROAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
5057 FRINK AVE, SAN DIEGO, CA 92117-1212
(757) 288-9512
Mailing address
5057 FRINK AVE, SAN DIEGO, CA 92117-1212
(757) 288-9512
Taxonomy
Speciality
Code
Description
License number
State
225XP0019X
Physical Rehabilitation Occupational Therapist
0119005572
VA
225XP0200X
Pediatric Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0119005572
LISCENSE NUMBER
VA
Enumeration date
03/08/2012
Last updated
07/21/2022
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