Provider Demographics
NPI:1720618002
Name:ROGERS, ANNA
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:ROGERS
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 1:18020 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:RUDYARD
Mailing Address - State:MI
Mailing Address - Zip Code:49780-9388
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18020 MEADOW LN
Practice Address - Street 2:
Practice Address - City:RUDYARD
Practice Address - State:MI
Practice Address - Zip Code:49780-9388
Practice Address - Country:US
Practice Address - Phone:419-612-9636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-25
Last Update Date:2020-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant