Provider Demographics
NPI:1083357545
Name:BROGDON, JALONTA
Entity type:Individual
Prefix:
First Name:JALONTA
Middle Name:
Last Name:BROGDON
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 1:72 DEEP WOODS TRL
Mailing Address - Street 2:
Mailing Address - City:ROXBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27574-6810
Mailing Address - Country:US
Mailing Address - Phone:336-504-6269
Mailing Address - Fax:
Practice Address - Street 1:72 DEEP WOODS TRL
Practice Address - Street 2:
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27574-6810
Practice Address - Country:US
Practice Address - Phone:336-504-6269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist