Provider Demographics
NPI:1487025748
Name:FRIDRICK, SHARON (OTR/L)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:FRIDRICK
Suffix:
Gender:F
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 1:3297 N LENA PL
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-4767
Mailing Address - Country:US
Mailing Address - Phone:253-331-5215
Mailing Address - Fax:
Practice Address - Street 1:3297 N LENA PL
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-4767
Practice Address - Country:US
Practice Address - Phone:253-331-5215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-13
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00002623225XP0200X
NC9169225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics