Provider Demographics
NPI:1912681925
Name:ROGERS, TIMOTHEA ROBERTA
Entity Type:Individual
Prefix:MRS
First Name:TIMOTHEA
Middle Name:ROBERTA
Last Name:ROGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:THEA
Other - Middle Name:R
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:152 MAUNEY CIR
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30512-1300
Mailing Address - Country:US
Mailing Address - Phone:770-653-3600
Mailing Address - Fax:
Practice Address - Street 1:164 NURSING HOME CIR
Practice Address - Street 2:
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512-3117
Practice Address - Country:US
Practice Address - Phone:706-745-4948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT000821225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist