Provider Demographics
NPI:1790370781
Name:ROGERS, ANNE THERESE (MOT OTR/L)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:THERESE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MOT OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 HAWTHORNE LN
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-9430
Mailing Address - Country:US
Mailing Address - Phone:317-332-9861
Mailing Address - Fax:317-893-4453
Practice Address - Street 1:3911 ELFIN AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-2021
Practice Address - Country:US
Practice Address - Phone:502-693-4677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-02
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY132487225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist