MEDICARE: MS. KATIE MARIE OGDEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician		OR
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1134244601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATIE MARIE OGDEN

Provider Business Mailing Address
First Line	:	PO BOX 1835
Second Line	:
City	:	GRANTS PASS
State	:	OR
Zip	:	97528-0156
Country	:	US
Telephone Number	:	541-415-9723
Fax Number	:

Provider Business Practice Location Address
First Line	:	2368 CRATER LAKE AVE STE 102
Second Line	:
City	:	MEDFORD
State	:	OR
Zip	:	97504-5006
Country	:	US
Telephone Number	:	541-415-9723
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	02/22/2021

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