Provider Demographics
NPI:1225670920
Name:KEDLEY BOGE, JUDY MARIE (COTA)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:MARIE
Last Name:KEDLEY BOGE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:JUDY
Other - Middle Name:K
Other - Last Name:BOGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COTA
Mailing Address - Street 1:3485 WINDSOR AVE
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-1312
Mailing Address - Country:US
Mailing Address - Phone:563-690-9637
Mailing Address - Fax:847-730-2159
Practice Address - Street 1:3485 WINDSOR AVE
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-1312
Practice Address - Country:US
Practice Address - Phone:563-557-7180
Practice Address - Fax:847-730-2159
Is Sole Proprietor?:No
Enumeration Date:2019-10-14
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00025224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant