Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XP0200X | Occupational Therapist - Pediatrics | 08012 | MD |
Y | 225XP0200X | Occupational Therapist - Pediatrics | 1855 | WV |
NPI | 1033666714 |
---|---|
Provider Name | Ms. Jennifer Rogers |
First Address | Cumberland, MD 21502-2416 |
Second Address | Cumberland, MD 21502-2416 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2016 |
Last Update Date | 09/09/2016 |