Provider Demographics
NPI:1316106354
Name:ROOF, LOUISA LOWELL (OTR/L)
Entity type:Individual
Prefix:MISS
First Name:LOUISA
Middle Name:LOWELL
Last Name:ROOF
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:LOUISA
Other - Middle Name:R
Other - Last Name:BROWNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:19 WOODSIDE RD
Mailing Address - Street 2:
Mailing Address - City:HARVARD
Mailing Address - State:MA
Mailing Address - Zip Code:01451-1616
Mailing Address - Country:US
Mailing Address - Phone:978-456-3941
Mailing Address - Fax:
Practice Address - Street 1:19 WOODSIDE RD
Practice Address - Street 2:
Practice Address - City:HARVARD
Practice Address - State:MA
Practice Address - Zip Code:01451-1616
Practice Address - Country:US
Practice Address - Phone:978-456-3941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA48225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0388904Medicaid