Provider Demographics
NPI:1255943320
Name:VOGEL, JESSICA FRYKBERG (OTR/L)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:FRYKBERG
Last Name:VOGEL
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 1:166 SAPELO PL
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-8744
Mailing Address - Country:US
Mailing Address - Phone:904-463-6134
Mailing Address - Fax:
Practice Address - Street 1:250 PALM COAST PKWY NE UNIT 209
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-8289
Practice Address - Country:US
Practice Address - Phone:386-597-1927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT18035225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist