Provider Demographics
NPI:1912258658
Name:VOGT, ANDREA L (MS,OTR/L)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:L
Last Name:VOGT
Suffix:
Gender:F
Credentials:MS,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8319 71ST ST NE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-8086
Mailing Address - Country:US
Mailing Address - Phone:727-686-2758
Mailing Address - Fax:
Practice Address - Street 1:17110 16TH DR NE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98271-5415
Practice Address - Country:US
Practice Address - Phone:360-652-4500
Practice Address - Fax:360-652-4502
Is Sole Proprietor?:No
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT60088857225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist