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General NPI Number Information
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NPI Number | 1598587156
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Entity Type | Individual
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Provider Name | KYLIE NOGA
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Gender | Female
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Dates
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Enumeration Date | 10/25/2024
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Last Update Date | 10/25/2024
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Provider Practice Location Address
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Address Line | 12 MAGNOLIA STREET
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City | EASTON
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State | MD
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Zip | 21601
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Country | US
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Telephone | 410-822-0330
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Fax |
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Provider Business Mailing Address
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Address Line | 514 DENNISON ROAD
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City | PATTERSONVILLE
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State | NY
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Zip | 12137
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 10378
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License Number State | MD
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