Healthcare Provider Details

I. General information

NPI: 1447189535
Provider Name (Legal Business Name): JESSICA ANN KOGUT M.S., OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8755 AERO DR STE 100
SAN DIEGO CA
92123-1750
US

IV. Provider business mailing address

893 NEWMAN AVE
SEEKONK MA
02771-4407
US

V. Phone/Fax

Practice location:
  • Phone: 619-578-2232
  • Fax:
Mailing address:
  • Phone: 508-904-6015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number29061
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: