Provider Demographics
NPI:1447481023
Name:ROESCH, ELIZABETH BULLER (LOTR)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:BULLER
Last Name:ROESCH
Suffix:
Gender:F
Credentials:LOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 KNOBCREST DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70507-3127
Mailing Address - Country:US
Mailing Address - Phone:337-896-7523
Mailing Address - Fax:337-896-7523
Practice Address - Street 1:301 KNOBCREST DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70507-3127
Practice Address - Country:US
Practice Address - Phone:337-896-7523
Practice Address - Fax:337-896-7523
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-30
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ10716225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist