Individual
JACQUELYN MARIE ROGGENBUCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
324 ROXBURY ROAD, ROCKFORD, IL 61107
(815) 398-9491
(815) 381-7498
Mailing address
PO BOX 735263, CHICAGO, IL 60673-5263
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056-011026
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41046100
—
WI
Enumeration date
05/08/2007
Last updated
09/13/2023
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