Provider Demographics
NPI:1043563281
Name:BOGE, ANNELISE (OTR/L)
Entity Type:Individual
Prefix:
First Name:ANNELISE
Middle Name:
Last Name:BOGE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ANNELISE
Other - Middle Name:
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:9520 PROTOTYPE CT
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-5916
Mailing Address - Country:US
Mailing Address - Phone:775-852-6323
Mailing Address - Fax:775-852-6321
Practice Address - Street 1:9520 PROTOTYPE CT
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-5916
Practice Address - Country:US
Practice Address - Phone:775-852-6323
Practice Address - Fax:775-852-6321
Is Sole Proprietor?:No
Enumeration Date:2012-10-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12-0200225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist