Healthcare Provider Details

I. General information

NPI: 1649003260
Provider Name (Legal Business Name): TAYLOR LOUISE ROGERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2024
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1480 N 400 E
LOGAN UT
84341-7525
US

IV. Provider business mailing address

3084 SOUTHCREEK DR
LINCOLN CA
95648-8286
US

V. Phone/Fax

Practice location:
  • Phone: 916-295-8022
  • Fax:
Mailing address:
  • Phone: 916-295-8022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number14040764-4003
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: