Provider Demographics
NPI:1194918151
Name:VOGEL, HEIDI ANN (OT)
Entity type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:ANN
Last Name:VOGEL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9456 SE SOUTHWORTH DR
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-8854
Mailing Address - Country:US
Mailing Address - Phone:360-769-8507
Mailing Address - Fax:
Practice Address - Street 1:9456 SE SOUTHWORTH DR
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-8854
Practice Address - Country:US
Practice Address - Phone:360-769-8507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-23
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00001259225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist