Provider Demographics
NPI:1063727329
Name:DIEROLF, ROXANNE K (LMT)
Entity type:Individual
Prefix:MRS
First Name:ROXANNE
Middle Name:K
Last Name:DIEROLF
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 3RD ST
Mailing Address - Street 2:P.O. BOX 511
Mailing Address - City:SHERRARD
Mailing Address - State:IL
Mailing Address - Zip Code:61281-7706
Mailing Address - Country:US
Mailing Address - Phone:309-593-9112
Mailing Address - Fax:
Practice Address - Street 1:405 3RD ST
Practice Address - Street 2:SUITE B
Practice Address - City:SHERRARD
Practice Address - State:IL
Practice Address - Zip Code:61281-7706
Practice Address - Country:US
Practice Address - Phone:309-593-9112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
173C00000X
IL227.011221225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No173C00000XOther Service ProvidersReflexologist