Provider Demographics
NPI:1942552757
Name:ROGERS, ELICIA MARIE (MOTR/L)
Entity Type:Individual
Prefix:
First Name:ELICIA
Middle Name:MARIE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16250 NE 74TH ST
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-7817
Mailing Address - Country:US
Mailing Address - Phone:425-936-1200
Mailing Address - Fax:
Practice Address - Street 1:16250 NE 74TH ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-7817
Practice Address - Country:US
Practice Address - Phone:425-936-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00004104225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist