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General NPI Number Information
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NPI Number | 1790982585
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Entity Type | Individual
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Provider Name | JESSICA IRENE BUZON VOGEL OTR
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Gender | Female
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Dates
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Enumeration Date | 06/27/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 904 ISAAC STREETS DR
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City | OREGON
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State | OH
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Zip | 43616-3204
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Country | US
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Telephone | 419-691-2483
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Fax |
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Provider Business Mailing Address
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Address Line | 102 RAISIN CIR
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City | DUNDEE
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State | MI
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Zip | 48131-9539
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Country | US
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Telephone | 734-529-7861
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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 | OT-5519
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 5201006369
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License Number State | MI
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