Provider Demographics
NPI:1750097853
Name:OGBORN, EMILY E
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:E
Last Name:OGBORN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 FRANCE DR APT 205
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32826-5511
Mailing Address - Country:US
Mailing Address - Phone:321-298-6888
Mailing Address - Fax:
Practice Address - Street 1:5240 BABCOCK ST NE STE 105
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-4615
Practice Address - Country:US
Practice Address - Phone:321-750-9803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician