Provider Demographics
NPI:1851648885
Name:HOGE, LEAH (OTR/L)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:HOGE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 KENWOOD AVE
Mailing Address - Street 2:APT 212
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-2100
Mailing Address - Country:US
Mailing Address - Phone:218-232-7274
Mailing Address - Fax:
Practice Address - Street 1:525 KENWOOD AVE
Practice Address - Street 2:APT 212
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-2100
Practice Address - Country:US
Practice Address - Phone:218-232-7274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5177-26225X00000X
MN104218225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist