Provider Demographics
NPI:1588999619
Name:ROGERS-AGRESTI, SUE
Entity type:Individual
Prefix:
First Name:SUE
Middle Name:
Last Name:ROGERS-AGRESTI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 SOMERVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-2111
Mailing Address - Country:US
Mailing Address - Phone:781-267-9082
Mailing Address - Fax:
Practice Address - Street 1:34 ELM ST
Practice Address - Street 2:
Practice Address - City:COHASSET
Practice Address - State:MA
Practice Address - Zip Code:02025-1829
Practice Address - Country:US
Practice Address - Phone:781-383-3811
Practice Address - Fax:781-383-3861
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2272224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant