Healthcare Provider Details

I. General information

NPI: 1366681496
Provider Name (Legal Business Name): AMY SUZAN ROGERS OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2009
Last Update Date: 02/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 E GRACE ST
RENSSELAER IN
47978-3211
US

IV. Provider business mailing address

635 S FROST DR
SAGINAW MI
48638-6083
US

V. Phone/Fax

Practice location:
  • Phone: 219-866-5141
  • Fax:
Mailing address:
  • Phone: 989-284-4535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number5201006443
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: