Provider Demographics
NPI:1265130702
Name:HOGLUND, GABRIELLE (OTR/L)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:HOGLUND
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 1:112 237TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:MN
Mailing Address - Zip Code:55005-9877
Mailing Address - Country:US
Mailing Address - Phone:763-464-2187
Mailing Address - Fax:
Practice Address - Street 1:28210 OLD TOWNE RD
Practice Address - Street 2:
Practice Address - City:CHISAGO CITY
Practice Address - State:MN
Practice Address - Zip Code:55013-9556
Practice Address - Country:US
Practice Address - Phone:651-257-0575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist