Provider Demographics
NPI:1225698277
Name:HENRY, FREDERIS ANN (COTA/L)
Entity Type:Individual
Prefix:
First Name:FREDERIS
Middle Name:ANN
Last Name:HENRY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:FREDERIS
Other - Middle Name:ANN
Other - Last Name:MOSES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:N/A
Mailing Address - Street 1:8 SCHOOL LN
Mailing Address - Street 2:
Mailing Address - City:STEVENS
Mailing Address - State:PA
Mailing Address - Zip Code:17578-9404
Mailing Address - Country:US
Mailing Address - Phone:717-330-8928
Mailing Address - Fax:
Practice Address - Street 1:620 PAXTON PL STE 102
Practice Address - Street 2:
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-8279
Practice Address - Country:US
Practice Address - Phone:717-723-8520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP009350224ZR0403X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224ZR0403XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantDriving and Community Mobility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOP009350OtherCOTA