Basic Information
| Provider Information | |||||||||
| NPI: | 1225670920 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KEDLEY BOGE | ||||||||
| FirstName: | JUDY | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | COTA | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | BOGE | ||||||||
| OtherFirstName: | JUDY | ||||||||
| OtherMiddleName: | K | ||||||||
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| OtherCredential: | COTA | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3485 WINDSOR AVE | ||||||||
| Address2: | |||||||||
| City: | DUBUQUE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 520011312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5636909637 | ||||||||
| FaxNumber: | 8477302159 | ||||||||
| Practice Location | |||||||||
| Address1: | 3485 WINDSOR AVE | ||||||||
| Address2: | |||||||||
| City: | DUBUQUE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 520011312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5635577180 | ||||||||
| FaxNumber: | 8477302159 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2019 | ||||||||
| LastUpdateDate: | 10/14/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 00025 | IA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.