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General NPI Number Information
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NPI Number | 1801356241
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Entity Type | Individual
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Provider Name | NICOLE TERESA OGLETREE
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Gender | Female
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Dates
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Enumeration Date | 03/21/2019
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Last Update Date | 01/27/2022
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Provider Practice Location Address
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Address Line | 1501 OLD BLACK HORSE PIKE APT F9
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City | BLACKWOOD
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State | NJ
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Zip | 08012-4927
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Country | US
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Telephone | 856-404-0904
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Fax | 856-373-5040
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Provider Business Mailing Address
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Address Line | 1501 OLD BLACK HORSE PIKE APT F9
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City | BLACKWOOD
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State | NJ
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Zip | 08012-4927
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Country | US
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Telephone | 856-404-0904
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Fax | 856-373-5040
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 18545
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA01967200
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License Number State | NJ
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