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NPI Code Detail

MEDICARE: STACY ROGALL

MEDICARE: STACY ROGALL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist1652-26WI

General Provider Information

NPI Number : 1093728842
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACY ROGALL
Provider Business Mailing Address
First Line : W4923 COUNTY ROAD G
Second Line :
City : PORTERFIELD
State : WI
Zip : 54159-9410
Country : US
Telephone Number : 715-789-3171
Fax Number :
Provider Business Practice Location Address
First Line : 831 PINE BEACH RD
Second Line :
City : MARINETTE
State : WI
Zip : 54143-4225
Country : US
Telephone Number : 715-732-5796
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/14/2006
Last Update Date : 07/12/2007

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Directions to “ STACY ROGALL ” Practice Location

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