Provider Demographics
NPI:1568780245
Name:ROGOWSKI, SUSAN (OTR/L, MPS, DROT)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:ROGOWSKI
Suffix:
Gender:F
Credentials:OTR/L, MPS, DROT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 PULASKI HWY
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-7009
Mailing Address - Country:US
Mailing Address - Phone:845-258-4456
Mailing Address - Fax:
Practice Address - Street 1:10 ROUTE 209
Practice Address - Street 2:PORT JERVIS CITY SCHOOL DISTRICT
Practice Address - City:PORT JERVIS
Practice Address - State:NY
Practice Address - Zip Code:12771-3920
Practice Address - Country:US
Practice Address - Phone:845-827-5360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-05
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005006-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist