Individual
CARLY MAYRE ROGERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, OTR/L
Contact information
Practice address
1431 15TH ST, MANHATTAN BEACH, CA 90266-4077
(310) 318-7345
Mailing address
2532 HERMOSA AVE APT C, HERMOSA BEACH, CA 90254-2515
(310) 251-8866
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
1071700
CA
Other
Enumeration date
04/11/2010
Last updated
04/11/2010
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