Healthcare Provider Details

I. General information

NPI: 1285095380
Provider Name (Legal Business Name): DAWN ROGERS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2016
Last Update Date: 06/13/2021
Certification Date: 06/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8168 HIGHWAY 789
LANDER WY
82520-2953
US

IV. Provider business mailing address

PO BOX 631 178 TRAIL DR
RANCHESTER WY
82839-0631
US

V. Phone/Fax

Practice location:
  • Phone: 307-332-5240
  • Fax:
Mailing address:
  • Phone: 307-751-8611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOTR514
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT-514
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: