Active NPI
Ethan Rogers, OTR/L
- Occupational Therapist
- Wyoming, MI
National Provider Identifier
1609412675
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- Practice address
- 3555 Copper River Ave SW
Wyoming, MI 49418-9791 - Phone
- (616) 369-7448
- NPI assigned
- Nov 25, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | |||
| Occupational Therapist | 225X00000X | Primary |
Addresses
Primary practice location
3555 Copper River Ave SW
Wyoming, MI 49418-9791
Mailing address
2555 Fox Run Rd SW Apt 10
Wyoming, MI 49519-5210
Other practice location 1
2555 Fox Run Rd SW Apt 10
Wyoming, MI 49519-5210
Phone (313) 720-8222
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1574640000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1620000000000",
"number": "1609412675",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2555 FOX RUN RD SW APT 10",
"city": "WYOMING",
"state": "MI",
"postal_code": "495195210"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3555 COPPER RIVER AVE SW",
"city": "WYOMING",
"state": "MI",
"postal_code": "494189791",
"telephone_number": "616-369-7448"
}
],
"practiceLocations": [
{
"address_1": "2555 Fox Run Rd SW Apt 10",
"address_purpose": "LOCATION",
"city": "Wyoming",
"state": "MI",
"postal_code": "495195210",
"country_code": "US",
"telephone_number": "313-720-8222",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ROGERS",
"first_name": "ETHAN",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-11-25",
"last_updated": "2021-05-03",
"certification_date": "2021-05-03",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wyoming, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.