Provider Demographics
NPI:1477943892
Name:HOGAN, KATHLEEN KAREN (ATC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:KAREN
Last Name:HOGAN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 WESTOVER AVE
Mailing Address - Street 2:APT 206
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-2309
Mailing Address - Country:US
Mailing Address - Phone:309-912-2807
Mailing Address - Fax:
Practice Address - Street 1:107 WESTOVER AVE
Practice Address - Street 2:APT 206
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-2309
Practice Address - Country:US
Practice Address - Phone:309-912-2807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-24
Last Update Date:2015-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260020152255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer