Healthcare Provider Details

I. General information

NPI: 1295286904
Provider Name (Legal Business Name): REBECCA OHLROGGE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2016
Last Update Date: 10/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 BELLVIEW AVENUE
WINCHESTER VA
22601
US

IV. Provider business mailing address

124 CALEDON COURT APARTMENT 7
STEPHENS CITY VA
22655
US

V. Phone/Fax

Practice location:
  • Phone: 540-542-0200
  • Fax:
Mailing address:
  • Phone: 757-918-5759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: