MEDICARE: MRS. MARYELLEN HARVEY OGREAN P.T.

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	225100000X	Physical Therapist	1483	CO

General Provider Information

NPI Number	:	1629190996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARYELLEN HARVEY OGREAN P.T.

Provider Business Mailing Address
First Line	:	4110 SAN FELICE PT
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-5947
Country	:	US
Telephone Number	:	719-540-3696
Fax Number	:

Provider Business Practice Location Address
First Line	:	6165 LEHMAN DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-3441
Country	:	US
Telephone Number	:	719-264-8524
Fax Number	:	719-264-8526

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

Provider Enumeration Date	:	04/06/2007
Last Update Date	:	07/08/2007

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