Corey Summerlin Roan, OTR/L

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

Practice address

5057 Frink Ave
San Diego, CA 92117-1212

Phone

(757) 288-9512

NPI assigned

Mar 8, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Milestone Pediatric Therapy, PC.

  • Home Health Agency
  • San Diego, CA
  • NPI 1821515305
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1331164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1730453747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5057 FRINK AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921171212",
            "telephone_number": "757-288-9512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5057 FRINK AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921171212",
            "telephone_number": "757-288-9512"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4142 Bonney Rd",
            "address_purpose": "LOCATION",
            "city": "Virginia Beach",
            "state": "VA",
            "postal_code": "234521711",
            "country_code": "US",
            "telephone_number": "757-340-0620",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROAN",
        "first_name": "COREY",
        "middle_name": "SUMMERLIN",
        "name_prefix": "Miss",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-03-08",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0019X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Physical Rehabilitation",
            "state": "VA",
            "license": "0119005572",
            "primary": false
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LISCENSE NUMBER",
            "identifier": "0119005572",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anna Roach
• Steven Roach
• Bilal Roache
• Keene Arthur Roadman, DNP, CRNA
• Roamcare Corporation
• Heidi Roark, DPT
• Tuongvi Roath
• Mark Francis Roback, D.M.D.
• Evelyn Katherine Robarts, MA, BSN
• Molly Robb, MSW

• Pediatric Occupational Therapist in San Diego, CA
• Providers in San Diego, CA by specialty
• Pediatric Occupational Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.