Healthcare Provider Details

I. General information

NPI: 1144035684
Provider Name (Legal Business Name): EMMA ROGERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2025
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 N WALTON BLVD STE 2AND4
BENTONVILLE AR
72712-4548
US

IV. Provider business mailing address

701 N WALTON BLVD STE 2AND4
BENTONVILLE AR
72712-4548
US

V. Phone/Fax

Practice location:
  • Phone: 479-250-9838
  • Fax:
Mailing address:
  • Phone: 479-250-9838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: