Healthcare Provider Details

I. General information

NPI: 1386481976
Provider Name (Legal Business Name): DIXIE OGDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2024
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1516 ROSE LN
FAIRMONT WV
26554-9242
US

IV. Provider business mailing address

1516 ROSE LN
FAIRMONT WV
26554-9242
US

V. Phone/Fax

Practice location:
  • Phone: 304-534-0957
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: