Individual
DEBORAH L FOGG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5784 DORIS DR, BROOKPARK, OH 44142-2108
(216) 990-9572
Mailing address
5784 DORIS DR, BROOKPARK, OH 44142-2108
(216) 990-9572
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
—
OH
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1805489
—
OH
Enumeration date
12/10/2020
Last updated
12/10/2020
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