Individual
MICHELLE HOGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1130 COLLINS RD, JEFFERSON, WI 53549-2939
(920) 674-6075
Mailing address
W292 CIRCLE DR, OCONOMOWOC, WI 53066-5518
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
671-26
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40670500
—
WI
Enumeration date
01/10/2007
Last updated
07/08/2007
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