Provider Demographics
NPI:1598327801
Name:ROGERS, DEREN ALANNA (COTA)
Entity Type:Individual
Prefix:MRS
First Name:DEREN
Middle Name:ALANNA
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 1:201 N 13TH ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63834-1450
Mailing Address - Country:US
Mailing Address - Phone:573-258-9719
Mailing Address - Fax:
Practice Address - Street 1:201 N 13TH ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:MO
Practice Address - Zip Code:63834-1450
Practice Address - Country:US
Practice Address - Phone:573-258-9719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty