Active NPI
Jennie L Roach, OTR/L
- Occupational Therapist
- Elizabeth City, NC
National Provider Identifier
1326213059
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 1704
- Practice address
- 901 Halstead Blvd
Elizabeth City, NC 27909-6920 - Phone
- (252) 338-0137
- Fax
- (252) 338-4512
- NPI assigned
- Apr 24, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 1704 | NC | Primary |
Addresses
Primary practice location
901 Halstead Blvd
Elizabeth City, NC 27909-6920
Mailing address
1110 Reid Dr
Elizabeth City, NC 27909-2724
Phone (252) 338-0137
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1704 | NC | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1208995200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1208995200000",
"number": "1326213059",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1110 REID DR",
"city": "ELIZABETH CITY",
"state": "NC",
"postal_code": "279092724",
"telephone_number": "252-338-0137",
"fax_number": "252-338-4512"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "901 HALSTEAD BLVD",
"city": "ELIZABETH CITY",
"state": "NC",
"postal_code": "279096920",
"telephone_number": "252-338-0137",
"fax_number": "252-338-4512"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROACH",
"first_name": "JENNIE",
"middle_name": "L",
"name_prefix": "Mrs.",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-04-24",
"last_updated": "2008-04-24",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NC",
"license": "1704",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elizabeth City, NC
- Donald Brent Richardson, PHARMD
- Brandon Patrick Riddick, LCMHC, NCC
- Katherine Snead Rinchetti, PH.D., LPC
- River City Chiropractic PC
- Rivershore Counseling and Consulting, LLC
- Roanoke Family Practice
- Carroll Bracey Robertson III, MD
- Jennifer Lynn Robertson, PHARM.D.
- Jill H Robertson, CRNA
- Joseph Letcher Robertson Jr., MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.