Provider Demographics
NPI:1851538227
Name:HOGOBOOM, LINDA JEAN (MS, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:JEAN
Last Name:HOGOBOOM
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:MS
Other - First Name:LINDA
Other - Middle Name:JEAN
Other - Last Name:LEITER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:21 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:BOONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07005-1105
Mailing Address - Country:US
Mailing Address - Phone:845-893-6214
Mailing Address - Fax:
Practice Address - Street 1:21 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:BOONTON
Practice Address - State:NJ
Practice Address - Zip Code:07005-1105
Practice Address - Country:US
Practice Address - Phone:845-893-6214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-07
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010649-1225X00000X, 225XP0200X
NJ46TR00436600225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist