Provider Demographics
NPI:1538904610
Name:ROGERS, ERIN GRACE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:GRACE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:ERIN
Other - Middle Name:GRACE
Other - Last Name:TIPTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:613 MAYFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37665-1248
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2412 KNOB CREEK RD
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-2586
Practice Address - Country:US
Practice Address - Phone:423-930-9001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-28
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7557225X00000X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist