Provider Demographics
NPI:1336030071
Name:ROESCH, WALTER (OTR)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:
Last Name:ROESCH
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 W YELLOW WOOD DR
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29680-3520
Mailing Address - Country:US
Mailing Address - Phone:864-607-0484
Mailing Address - Fax:
Practice Address - Street 1:1305 BOILING SPRINGS RD
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-4139
Practice Address - Country:US
Practice Address - Phone:864-458-7566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-11
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6983225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist