Provider Demographics
NPI:1669181442
Name:VOGEL, SHULAMIS N (OT)
Entity type:Individual
Prefix:
First Name:SHULAMIS
Middle Name:N
Last Name:VOGEL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 JENNY LN
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-5028
Mailing Address - Country:US
Mailing Address - Phone:917-435-1359
Mailing Address - Fax:
Practice Address - Street 1:3 JENNY LN
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-5028
Practice Address - Country:US
Practice Address - Phone:917-435-1359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00679000225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ46TR00679000OtherOCCUPATIONAL THERAPY ADVISORY COUNCIL