Provider Demographics
NPI:1114263795
Name:ROGERS, KATIE ALLISON
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:ALLISON
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 1:114406 S 4710 RD
Mailing Address - Street 2:
Mailing Address - City:MULDROW
Mailing Address - State:OK
Mailing Address - Zip Code:74948-6874
Mailing Address - Country:US
Mailing Address - Phone:479-629-2463
Mailing Address - Fax:
Practice Address - Street 1:8200 DODGE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4113
Practice Address - Country:US
Practice Address - Phone:402-955-6341
Practice Address - Fax:402-955-7396
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-30
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1929OtherSTATE LICENSE
302359OtherNATIONALS
AROTR2581OtherSTATE LICENSE