Provider Demographics
NPI:1073664355
Name:RODGERS, HOLLY E (OTR)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:E
Last Name:RODGERS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3141 DELAWAY LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46217-7014
Mailing Address - Country:US
Mailing Address - Phone:317-989-8780
Mailing Address - Fax:317-851-8688
Practice Address - Street 1:3141 DELAWAY LN
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46217-7014
Practice Address - Country:US
Practice Address - Phone:317-989-8780
Practice Address - Fax:317-851-8688
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31003446A225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics