Provider Demographics
NPI:1083336622
Name:FOGAL, JESSICA (OTD, OTR/L)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:FOGAL
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2617 STEPHENSON DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-3825
Mailing Address - Country:US
Mailing Address - Phone:302-668-3465
Mailing Address - Fax:
Practice Address - Street 1:2617 STEPHENSON DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-3825
Practice Address - Country:US
Practice Address - Phone:302-668-3465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist