Basic Information
| Provider Information | |||||||||
| NPI: | 1750588612 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VOGL | ||||||||
| FirstName: | SUE | ||||||||
| MiddleName: | TEVIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17494 N RIGHT FORK RD | ||||||||
| Address2: | |||||||||
| City: | HAUSER | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838545582 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 414 S UNIVERSITY RD | ||||||||
| Address2: | |||||||||
| City: | SPOKANE VALLEY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992065555 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5099244650 | ||||||||
| FaxNumber: | 5092280851 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 0C0000250 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.