Basic Information
| Provider Information | |||||||||
| NPI: | 1255943320 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VOGEL | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | FRYKBERG | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 166 SAPELO PL | ||||||||
| Address2: | |||||||||
| City: | SAINT JOHNS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322598744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9044636134 | ||||||||
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| Practice Location | |||||||||
| Address1: | 250 PALM COAST PKWY NE UNIT 209 | ||||||||
| Address2: | |||||||||
| City: | PALM COAST | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321378289 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3865971927 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2020 | ||||||||
| LastUpdateDate: | 08/20/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT18035 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.