Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 2114 | AL |
NPI | 1114115722 |
---|---|
Provider Name | Mrs. Crystal Bates Rogers |
First Address | Fairhope, AL 36532-1902 |
Second Address | Fairhope, AL 36532-1902 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2007 |
Last Update Date | 20/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
631187140 | TAX ID (01) | AL |