Basic Information
| Provider Information | |||||||||
| NPI: | 1891872289 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOGREN | ||||||||
| FirstName: | EMILY | ||||||||
| MiddleName: | KRISTIN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MOT, OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7640 FOREST WAY | ||||||||
| Address2: | |||||||||
| City: | ROSCOE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 610738492 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153899487 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3616 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | ROCKFORD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 611032159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8158775932 | ||||||||
| FaxNumber: | 8158776302 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.