Individual
REBECCA NICOLE ROE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
25 WHITEBUSH WAY, ASTORIA, OR 97103
(510) 846-2508
Mailing address
25 WHITEBUSH WAY, ASTORIA, OR 97103-5750
(510) 846-2508
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
1067048
OR
Other
Enumeration date
09/02/2011
Last updated
09/02/2011
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