MEDICARE: THERESA A ROGOZINSKI

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
1	225X00000X	Occupational Therapist	010835-1	NY

General Provider Information

NPI Number	:	1144453697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA A ROGOZINSKI

Provider Business Mailing Address
First Line	:	310 LAKE SHORE DR
Second Line	:
City	:	MONROE
State	:	NY
Zip	:	10950-1812
Country	:	US
Telephone Number	:	845-782-0096
Fax Number	:

Provider Business Practice Location Address
First Line	:	310 LAKE SHORE DR
Second Line	:
City	:	MONROE
State	:	NY
Zip	:	10950-1812
Country	:	US
Telephone Number	:	845-782-0096
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2009
Last Update Date	:	09/01/2009

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Directions to “ THERESA A ROGOZINSKI ” Practice Location

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