Provider Demographics
NPI:1053831495
Name:FREEMAN, ETHAN SOLOMON (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:ETHAN
Middle Name:SOLOMON
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1861 POWDER MILL RD
Mailing Address - Street 2:ATTN MEDICAL STAFF OFFICE
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-4723
Mailing Address - Country:US
Mailing Address - Phone:717-718-2041
Mailing Address - Fax:717-747-2102
Practice Address - Street 1:470 EISENHOWER DR
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-5248
Practice Address - Country:US
Practice Address - Phone:717-633-0031
Practice Address - Fax:717-630-1085
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA119112225X00000X
PAOC014936225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist