Provider Demographics
NPI:1841545860
Name:FRACH, JESSICA DIANE (OT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:DIANE
Last Name:FRACH
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13352 ABERDEEN ST NE STE A
Mailing Address - Street 2:
Mailing Address - City:HAM LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55304-6877
Mailing Address - Country:US
Mailing Address - Phone:763-786-5585
Mailing Address - Fax:
Practice Address - Street 1:13352 ABERDEEN ST NE STE A
Practice Address - Street 2:
Practice Address - City:HAM LAKE
Practice Address - State:MN
Practice Address - Zip Code:55304-6877
Practice Address - Country:US
Practice Address - Phone:763-786-5585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN104621225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist