Individual
STEPHANIE ROGERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2105 12TH AVE RD, NAMPA, ID 83686-6312
(208) 467-5721
Mailing address
2105 12TH AVE RD, NAMPA, ID 83686-6312
(208) 467-5721
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT-606
ID
Other
Enumeration date
10/11/2016
Last updated
10/11/2016
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