Provider Demographics
NPI:1689259905
Name:ROGERS, STEPHEN W (COTA)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:W
Last Name:ROGERS
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 WHISPERING PINES DR
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:SC
Mailing Address - Zip Code:29369-9748
Mailing Address - Country:US
Mailing Address - Phone:864-621-7421
Mailing Address - Fax:
Practice Address - Street 1:11 E AUGUSTA PL
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-1755
Practice Address - Country:US
Practice Address - Phone:864-991-8398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5219224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant