Provider Demographics
NPI:1790982585
Name:VOGEL, JESSICA IRENE BUZON (OTR)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:IRENE BUZON
Last Name:VOGEL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 RAISIN CIR
Mailing Address - Street 2:
Mailing Address - City:DUNDEE
Mailing Address - State:MI
Mailing Address - Zip Code:48131-9539
Mailing Address - Country:US
Mailing Address - Phone:734-529-7861
Mailing Address - Fax:
Practice Address - Street 1:904 ISAAC STREETS DR
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3204
Practice Address - Country:US
Practice Address - Phone:419-691-2483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT-5519225X00000X
MI5201006369225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist