Provider Demographics
NPI:1538340781
Name:RICE, ROGER CHARLES (OTR)
Entity type:Individual
Prefix:MR
First Name:ROGER
Middle Name:CHARLES
Last Name:RICE
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 RANDLE DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-3343
Mailing Address - Country:US
Mailing Address - Phone:254-741-1476
Mailing Address - Fax:254-741-1476
Practice Address - Street 1:1103 MARY JANE ST
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513-3731
Practice Address - Country:US
Practice Address - Phone:254-939-9327
Practice Address - Fax:254-939-9730
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106916225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist