MEDICARE: KRISTIN MARY ROGAN OTR/L

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	9050	NC

General Provider Information

NPI Number	:	1972866614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN MARY ROGAN OTR/L

Provider Business Mailing Address
First Line	:	525 S WHITE ST
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-2920
Country	:	US
Telephone Number	:	984-289-3890
Fax Number	:

Provider Business Practice Location Address
First Line	:	525 S WHITE ST
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-2920
Country	:	US
Telephone Number	:	984-289-3890
Fax Number	:

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

Provider Enumeration Date	:	06/18/2012
Last Update Date	:	10/31/2025

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