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General NPI Number Information
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NPI Number | 1336729409
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Entity Type | Individual
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Provider Name | THEODORE EDWARD OGILVIE JR.
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Gender | Male
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Dates
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Enumeration Date | 04/12/2021
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Last Update Date | 04/12/2021
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Provider Practice Location Address
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Address Line | 7949 E ACOMA DR
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-6904
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Country | US
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Telephone | 530-515-5814
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Fax |
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Provider Business Mailing Address
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Address Line | 7949 E ACOMA DR
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-6904
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | ATR-009253
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License Number State | AZ
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