Provider Demographics
NPI:1992010706
Name:ROGERS, TOREY BETHANY (COTA)
Entity type:Individual
Prefix:
First Name:TOREY
Middle Name:BETHANY
Last Name:ROGERS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 PROFESSIONAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-5244
Mailing Address - Country:US
Mailing Address - Phone:931-552-3002
Mailing Address - Fax:931-647-8246
Practice Address - Street 1:900 PROFESSIONAL PARK DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-5244
Practice Address - Country:US
Practice Address - Phone:931-552-3002
Practice Address - Fax:931-647-8246
Is Sole Proprietor?:No
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1899224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant