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NPI Code Detail

MEDICARE: JESSICA FRYKBERG VOGEL OTR/L

MEDICARE: JESSICA FRYKBERG VOGEL OTR/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational TherapistOT18035FL

General Provider Information

NPI Number : 1255943320
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA FRYKBERG VOGEL OTR/L
Provider Business Mailing Address
First Line : 166 SAPELO PL
Second Line :
City : SAINT JOHNS
State : FL
Zip : 32259-8744
Country : US
Telephone Number : 904-463-6134
Fax Number :
Provider Business Practice Location Address
First Line : 250 PALM COAST PKWY NE UNIT 209
Second Line :
City : PALM COAST
State : FL
Zip : 32137-8289
Country : US
Telephone Number : 386-597-1927
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2020
Last Update Date : 08/20/2020

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