Provider Demographics
NPI:1013553791
Name:MOGI, JESSICA CYNTHIA (OTR/L)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:CYNTHIA
Last Name:MOGI
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13514 AUBURN CT
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-3449
Mailing Address - Country:US
Mailing Address - Phone:909-900-5871
Mailing Address - Fax:
Practice Address - Street 1:2061 WRIGHT AVE STE A7
Practice Address - Street 2:
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-5813
Practice Address - Country:US
Practice Address - Phone:909-519-8912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-18
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20481225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist