Provider Demographics
NPI:1891496766
Name:HOGUE, JAN TRITTIPOE (COTA/L)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:TRITTIPOE
Last Name:HOGUE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:JAN
Other - Middle Name:TRITTIPOE
Other - Last Name:FAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:4905 DICKENS RD STE 106
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-1953
Mailing Address - Country:US
Mailing Address - Phone:804-638-5047
Mailing Address - Fax:
Practice Address - Street 1:11901 REEDY BRANCH RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23838-4235
Practice Address - Country:US
Practice Address - Phone:804-638-5047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131002054224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant