Provider Demographics
NPI:1316378391
Name:ROESER, DARCY (OTR/L)
Entity type:Individual
Prefix:
First Name:DARCY
Middle Name:
Last Name:ROESER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:MN
Mailing Address - Zip Code:55328-2828
Mailing Address - Country:US
Mailing Address - Phone:763-972-6332
Mailing Address - Fax:
Practice Address - Street 1:530 W 2ND ST
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:MN
Practice Address - Zip Code:55328-2828
Practice Address - Country:US
Practice Address - Phone:763-972-6332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN102634225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist