Provider Demographics
NPI:1417375833
Name:ROGERS, CHRISTINE BOLANDER (OTR/L)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:BOLANDER
Last Name:ROGERS
Suffix:
Gender:F
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 1:10804 CREEDE CREEK PT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80908-7406
Mailing Address - Country:US
Mailing Address - Phone:443-848-7545
Mailing Address - Fax:
Practice Address - Street 1:1160 LAKE PLAZA DR
Practice Address - Street 2:SUITE 200
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-3506
Practice Address - Country:US
Practice Address - Phone:719-597-0822
Practice Address - Fax:719-599-4606
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-02
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0003901225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist