Provider Demographics
NPI:1982996419
Name:OGREN, ANGELA DANAE (MT-BC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:DANAE
Last Name:OGREN
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12617 NETHERHALL DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-8404
Mailing Address - Country:US
Mailing Address - Phone:843-437-4089
Mailing Address - Fax:
Practice Address - Street 1:11492 ELDER AVE SW
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98367-7737
Practice Address - Country:US
Practice Address - Phone:843-437-4089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-02
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist