Healthcare Provider Details

I. General information

NPI: 1659433753
Provider Name (Legal Business Name): JEAN L. OGBURN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 11/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 TOM BELL RD C
MURPHYS CA
95247-9585
US

IV. Provider business mailing address

245 TOM BELL RD C
MURPHYS CA
95247-9585
US

V. Phone/Fax

Practice location:
  • Phone: 209-728-0744
  • Fax: 209-728-0125
Mailing address:
  • Phone: 209-728-0744
  • Fax: 209-728-0125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number2494
License Number StateCA

VIII. Authorized Official

Name: MS. JEAN L. OGBURN
Title or Position: OWNER-ADMINISTRATOR
Credential: M.A., C.C.C.,SLP
Phone: 209-728-0744