MEDICARE: JEREMY OGDEN OTR

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	225X00000X	Occupational Therapist	8129	NC

General Provider Information

NPI Number	:	1306056700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMY OGDEN OTR

Provider Business Mailing Address
First Line	:	4504 CRAWDAD CT
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28405-2326
Country	:	US
Telephone Number	:	330-931-0037
Fax Number	:

Provider Business Practice Location Address
First Line	:	4504 CRAWDAD CT
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28405-2326
Country	:	US
Telephone Number	:	330-931-0037
Fax Number	:

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

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	08/07/2012

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