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NPI Code Detail

MEDICARE: MRS. SUSAN LYNN ROGERS

MEDICARE: MRS. SUSAN LYNN ROGERS
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 Therapist5201002782MI

General Provider Information

NPI Number : 1568959484
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SUSAN LYNN ROGERS
Provider Business Mailing Address
First Line : 39312 WOODWARD AVE
Second Line :
City : BLOOMFIELD HILLS
State : MI
Zip : 48304-5007
Country : US
Telephone Number : 248-644-5522
Fax Number :
Provider Business Practice Location Address
First Line : 39312 WOODWARD AVE
Second Line :
City : BLOOMFIELD HILLS
State : MI
Zip : 48304-5007
Country : US
Telephone Number : 248-644-5522
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/16/2018
Last Update Date : 04/16/2018

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