Healthcare Provider Details

I. General information

NPI: 1073458667
Provider Name (Legal Business Name): ALLIE ROGERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 HALSEY TER
HARRISONVILLE MO
64701-1577
US

IV. Provider business mailing address

1104 HALSEY TER
HARRISONVILLE MO
64701-1577
US

V. Phone/Fax

Practice location:
  • Phone: 816-347-2400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: