Healthcare Provider Details

I. General information

NPI: 1699739763
Provider Name (Legal Business Name): JESSICA J OGREN O.T.R.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1970 CHRISTENSEN AVE
SAINT PAUL MN
55118-5105
US

IV. Provider business mailing address

10608 ALISON WAY
INVER GROVE HEIGHTS MN
55077-5471
US

V. Phone/Fax

Practice location:
  • Phone: 651-554-0926
  • Fax:
Mailing address:
  • Phone: 651-686-1094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XE1200X
TaxonomyErgonomics Occupational Therapist
License Number100806
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: