Healthcare Provider Details

I. General information

NPI: 1912396052
Provider Name (Legal Business Name): GARRY OGILVIE CO, FAAOP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2015
Last Update Date: 01/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 WH SMITH BLVD SUITE 108
GREENVILLE NC
27834-5199
US

IV. Provider business mailing address

1025 WH SMITH BLVD SUITE 108
GREENVILLE NC
27834-5199
US

V. Phone/Fax

Practice location:
  • Phone: 252-215-2215
  • Fax: 252-215-2216
Mailing address:
  • Phone: 252-215-2215
  • Fax: 252-215-2216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: