Provider Demographics
NPI:1689391807
Name:ROGOWSKY, MIKENNA ELISE (OTR/L)
Entity Type:Individual
Prefix:
First Name:MIKENNA
Middle Name:ELISE
Last Name:ROGOWSKY
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 1:9093 RIDGEFIELD DR STE 102
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-6711
Mailing Address - Country:US
Mailing Address - Phone:301-846-4769
Mailing Address - Fax:301-846-0059
Practice Address - Street 1:9093 RIDGEFIELD DR STE 102
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-6711
Practice Address - Country:US
Practice Address - Phone:301-846-4769
Practice Address - Fax:301-846-0059
Is Sole Proprietor?:No
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09812225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics