Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 5201006443 | MI |
NPI | 1366681496 |
---|---|
Provider Name | Amy Suzan Rogers |
First Address | Saginaw, MI 48638-6083 |
Second Address | Rensselaer, IN 47978-3211 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2009 |
Last Update Date | 12/02/2009 |