Provider Demographics
NPI:1962180349
Name:GOGEL, SHAINA MARIE
Entity type:Individual
Prefix:
First Name:SHAINA
Middle Name:MARIE
Last Name:GOGEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19518 N COUNTY ROAD 600 E
Mailing Address - Street 2:
Mailing Address - City:DALE
Mailing Address - State:IN
Mailing Address - Zip Code:47523-9568
Mailing Address - Country:US
Mailing Address - Phone:812-639-9410
Mailing Address - Fax:
Practice Address - Street 1:1579 S FOLSOMVILLE RD
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47601-9465
Practice Address - Country:US
Practice Address - Phone:812-639-9410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist