Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT00001535 | WA |
N | 225XH1200X | Occupational Therapist - Hand | OT00001535 | WA |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | OT00001535 | WA |
NPI | 1588931208 |
---|---|
Provider Name | Ms. Kelley Ruth Rogers |
First Address | Belfast, ME 04915-4003 |
Second Address | Olympia, WA 98502-8654 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/11/2011 |
Last Update Date | 09/03/2016 |