Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 002226-1 | NY |
NPI | 1023254679 |
---|---|
Provider Name | Ms. Jill Rogers |
First Address | Lockport, NY 14094-9721 |
Second Address | Lockport, NY 14094-9721 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2009 |
Last Update Date | 05/01/2009 |