Provider Demographics
NPI:1518376094
Name:HOGATE, TERESA PUHALLA (OTR/L)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:PUHALLA
Last Name:HOGATE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:
Other - Last Name:PUHALLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:PO BOX 84
Mailing Address - Street 2:572 OLD DEERFIELD PIKE
Mailing Address - City:DEERFIELD STREET
Mailing Address - State:NJ
Mailing Address - Zip Code:08313-0084
Mailing Address - Country:US
Mailing Address - Phone:856-451-2034
Mailing Address - Fax:
Practice Address - Street 1:572 OLD DEERFIELD PIKE
Practice Address - Street 2:84
Practice Address - City:DEERFIELD STREET
Practice Address - State:NJ
Practice Address - Zip Code:08313-0084
Practice Address - Country:US
Practice Address - Phone:856-451-2034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00161000225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist