Provider Demographics
NPI:1649771601
Name:BUGTONG, JESSICA ESTELLE
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:ESTELLE
Last Name:BUGTONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 HULL DR
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:MD
Mailing Address - Zip Code:21037-4131
Mailing Address - Country:US
Mailing Address - Phone:301-806-2445
Mailing Address - Fax:
Practice Address - Street 1:101 BRADDOCK RD
Practice Address - Street 2:
Practice Address - City:FROSTBURG
Practice Address - State:MD
Practice Address - Zip Code:21532-2303
Practice Address - Country:US
Practice Address - Phone:301-806-2445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-26
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer