Provider Demographics
NPI:1346295946
Name:DILL, FREDERICK MICHAEL (COTA)
Entity Type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:MICHAEL
Last Name:DILL
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 MUNRO AVE
Mailing Address - Street 2:
Mailing Address - City:W KEANSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:07734-3027
Mailing Address - Country:US
Mailing Address - Phone:732-495-4595
Mailing Address - Fax:
Practice Address - Street 1:125 MUNROE AVE
Practice Address - Street 2:
Practice Address - City:W KEANSBURG
Practice Address - State:NJ
Practice Address - Zip Code:07734-3027
Practice Address - Country:US
Practice Address - Phone:732-495-4595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant