Individual
ETHAN ROGERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
3555 COPPER RIVER AVE SW, WYOMING, MI 49418-9791
(616) 369-7448
Mailing address
2555 FOX RUN RD SW APT 10, WYOMING, MI 49519-5210
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
225X00000X
Occupational Therapist
Primary
—
—
Other
Enumeration date
11/25/2019
Last updated
05/03/2021
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