Provider Demographics
NPI:1275924177
Name:FRALEY, ROBERT JEREMY (OTR/L)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JEREMY
Last Name:FRALEY
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:767 N WEST ST UNIT 4
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45133-1175
Mailing Address - Country:US
Mailing Address - Phone:740-352-2016
Mailing Address - Fax:
Practice Address - Street 1:767 N WEST ST UNIT 4
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133-1175
Practice Address - Country:US
Practice Address - Phone:740-352-2016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT.006245225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist