Healthcare Provider Details

I. General information

NPI: 1023305810
Provider Name (Legal Business Name): DENISE RENAE ROKKE O.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2011
Last Update Date: 08/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W MIDDLE ST
CHELSEA MI
48118
US

IV. Provider business mailing address

13047 HADLEY RD
GREGORY MI
48137-9710
US

V. Phone/Fax

Practice location:
  • Phone: 734-475-3705
  • Fax:
Mailing address:
  • Phone: 507-461-2688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number100949
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201009249
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: