=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558038703
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEATHER M ROGERS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/25/2021
-----------------------------------------------------
Last Update Date | 08/25/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1515 BROOKSTONE BLVD
-----------------------------------------------------
City | PAINESVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44077-8210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-027-0030
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 888 FORD RD
-----------------------------------------------------
City | HIGHLAND HEIGHTS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44143-3102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-318-6217
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 224Z00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapy Assistant
-----------------------------------------------------
License Number | 0007329
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------