Provider Demographics
NPI:1275285009
Name:OLANSEN ROTH, ANN-MARIE (OT)
Entity type:Individual
Prefix:
First Name:ANN-MARIE
Middle Name:
Last Name:OLANSEN ROTH
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:
Other - Last Name:OLANSEN ROTH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:863 N MAIN ST EXT
Mailing Address - Street 2:STE 200
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-4999
Mailing Address - Country:US
Mailing Address - Phone:203-265-3280
Mailing Address - Fax:203-741-6569
Practice Address - Street 1:863 N MAIN ST EXT
Practice Address - Street 2:STE 200
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-4999
Practice Address - Country:US
Practice Address - Phone:203-265-3280
Practice Address - Fax:203-741-6569
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-24
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001094225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand