Provider Demographics
NPI:1801083167
Name:OGLE, DANA YVETTE (PTA)
Entity type:Individual
Prefix:MRS
First Name:DANA
Middle Name:YVETTE
Last Name:OGLE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MRS
Other - First Name:DANA
Other - Middle Name:YVETTE
Other - Last Name:MARLOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:19130 SUNNY ACRES RD
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:IL
Mailing Address - Zip Code:62675-7306
Mailing Address - Country:US
Mailing Address - Phone:217-632-2334
Mailing Address - Fax:
Practice Address - Street 1:19130 SUNNY ACRES RD
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:IL
Practice Address - Zip Code:62675-7306
Practice Address - Country:US
Practice Address - Phone:217-632-2334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160-002274225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL160-002274OtherPTA LICENSE