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General NPI Number Information
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NPI Number | 1902919129
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Entity Type | Individual
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Provider Name | MS. KIMBERLY OGLE
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Gender | Female
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Dates
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Enumeration Date | 08/15/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 205 E CLINTON ST
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City | JOLIET
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State | IL
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Zip | 60432-2854
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Country | US
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Telephone | 708-726-2468
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Fax | 708-726-4431
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Provider Business Mailing Address
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Address Line | 801 S BRIGGS ST 2ND FLOOR
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City | JOLIET
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State | IL
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Zip | 60433-9591
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Country | US
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Telephone | 815-726-2463
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Fax | 815-726-4431
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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 | 70003620
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License Number State | IL
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