Provider Demographics
NPI:1043598121
Name:RODGERS, ALLEN BRUCE (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:ALLEN
Middle Name:BRUCE
Last Name:RODGERS
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16257 SHAFTESBURY LN
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-1151
Mailing Address - Country:US
Mailing Address - Phone:586-884-6349
Mailing Address - Fax:
Practice Address - Street 1:16257 SHAFTESBURY LN
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-1151
Practice Address - Country:US
Practice Address - Phone:586-884-6349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-24
Last Update Date:2011-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201006855225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist