Provider Demographics
NPI:1043683139
Name:BOOGAR, JANELLE ELIZABETH
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:ELIZABETH
Last Name:BOOGAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4005 METZEROTT RD
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20740-2080
Mailing Address - Country:US
Mailing Address - Phone:352-552-8909
Mailing Address - Fax:407-905-9309
Practice Address - Street 1:4005 METZEROTT RD
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-2080
Practice Address - Country:US
Practice Address - Phone:352-552-8909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-11
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT20928225X00000X
FLOT 16843225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist