Provider Demographics
NPI:1235687583
Name:ROGERS, SHELBY LYNN (COTA)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:LYNN
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 1:119 W H AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-8733
Mailing Address - Country:US
Mailing Address - Phone:501-772-3224
Mailing Address - Fax:501-771-7648
Practice Address - Street 1:119 W H AVE
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-8733
Practice Address - Country:US
Practice Address - Phone:501-772-3224
Practice Address - Fax:501-771-7648
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-15
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A1136224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant