Healthcare Provider Details

I. General information

NPI: 1215511704
Provider Name (Legal Business Name): LEAH MAYELA ROGERS MOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2021
Last Update Date: 05/10/2021
Certification Date: 05/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1906 DUNCAN REIDVILLE RD
DUNCAN SC
29334-9447
US

IV. Provider business mailing address

1906 DUNCAN REIDVILLE RD
DUNCAN SC
29334-9447
US

V. Phone/Fax

Practice location:
  • Phone: 864-363-8001
  • Fax:
Mailing address:
  • Phone: 864-363-8001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number6135
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: