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NPI Code Detail

MEDICARE: NATHANIEL OGG

MEDICARE: NATHANIEL OGG
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
1225100000XPhysical TherapistPT016390OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PT016390OTHEROHSTATE LICENSE

General Provider Information

NPI Number : 1184074445
Entity Type Code : Individual
Provider Name (Legal Business Name) : NATHANIEL OGG
Provider Business Mailing Address
First Line : 276 FEDERAL AVE NW
Second Line :
City : MASSILLON
State : OH
Zip : 44647-5469
Country : US
Telephone Number : 330-833-2085
Fax Number : 330-833-2067
Provider Business Practice Location Address
First Line : 276 FEDERAL AVE NW
Second Line :
City : MASSILLON
State : OH
Zip : 44647-5469
Country : US
Telephone Number : 330-833-2085
Fax Number : 330-833-2067
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2016
Last Update Date : 06/17/2016

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