Provider Demographics
NPI:1821446303
Name:HACKWORTH-ROGERS, CYNTHIA (OTR/L, ATP)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:HACKWORTH-ROGERS
Suffix:
Gender:F
Credentials:OTR/L, ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 COTTONWOOD CREEK DR
Mailing Address - Street 2:
Mailing Address - City:TIPP CITY
Mailing Address - State:OH
Mailing Address - Zip Code:45371-2732
Mailing Address - Country:US
Mailing Address - Phone:937-877-0904
Mailing Address - Fax:
Practice Address - Street 1:835 COTTONWOOD CREEK DR
Practice Address - Street 2:
Practice Address - City:TIPP CITY
Practice Address - State:OH
Practice Address - Zip Code:45371-2732
Practice Address - Country:US
Practice Address - Phone:937-877-0904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2296225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation