Provider Demographics
NPI:1346665072
Name:ROGGENBUCK, KAYLA BETH (OTRL, CTRS)
Entity type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:BETH
Last Name:ROGGENBUCK
Suffix:
Gender:F
Credentials:OTRL, CTRS
Other - Prefix:MISS
Other - First Name:KAYLA
Other - Middle Name:BETH
Other - Last Name:MCGUIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 N SQUIRREL RD
Mailing Address - Street 2:APT 912
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-4015
Mailing Address - Country:US
Mailing Address - Phone:810-837-0775
Mailing Address - Fax:
Practice Address - Street 1:34025 HARPER AVE
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48035-3737
Practice Address - Country:US
Practice Address - Phone:586-445-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-05
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL144678225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist