MEDICARE: MRS. JESSICA J OGREN O.T.R.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XE1200X	Ergonomics Occupational Therapist	100806	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	100806	OTHER	MN	STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1699739763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSICA J OGREN O.T.R.

Provider Business Mailing Address
First Line	:	10608 ALISON WAY
Second Line	:
City	:	INVER GROVE HEIGHTS
State	:	MN
Zip	:	55077-5471
Country	:	US
Telephone Number	:	651-686-1094
Fax Number	:

Provider Business Practice Location Address
First Line	:	1970 CHRISTENSEN AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55118-5105
Country	:	US
Telephone Number	:	651-554-0926
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	07/08/2007

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