Provider Demographics
NPI:1295030658
Name:FOGG, GEORGETTE ANN (OTR/L, CHT)
Entity Type:Individual
Prefix:
First Name:GEORGETTE
Middle Name:ANN
Last Name:FOGG
Suffix:
Gender:F
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9365 MCKNIGHT RD STE 300
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-5901
Mailing Address - Country:US
Mailing Address - Phone:412-630-9750
Mailing Address - Fax:412-630-9761
Practice Address - Street 1:9365 MCKNIGHT RD STE 300
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-5901
Practice Address - Country:US
Practice Address - Phone:412-630-9750
Practice Address - Fax:412-630-9761
Is Sole Proprietor?:No
Enumeration Date:2011-01-17
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC006828L225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand