Provider Demographics
NPI:1629850409
Name:OGLE, CHASE ALLEN-TOBIAS
Entity Type:Individual
Prefix:
First Name:CHASE
Middle Name:ALLEN-TOBIAS
Last Name:OGLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 E BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-2271
Mailing Address - Country:US
Mailing Address - Phone:765-461-1245
Mailing Address - Fax:
Practice Address - Street 1:2430 S BUSINESS 31
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IN
Practice Address - Zip Code:46970-7188
Practice Address - Country:US
Practice Address - Phone:765-460-5071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-21-156232106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician