Provider Demographics
NPI:1497158752
Name:WOLODIN, FREDRICK (MS OTR/L)
Entity Type:Individual
Prefix:
First Name:FREDRICK
Middle Name:
Last Name:WOLODIN
Suffix:
Gender:M
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 HOBART AVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-3917
Mailing Address - Country:US
Mailing Address - Phone:646-808-9899
Mailing Address - Fax:646-808-9899
Practice Address - Street 1:2012 HOBART AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-3917
Practice Address - Country:US
Practice Address - Phone:646-808-9899
Practice Address - Fax:646-808-9899
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-01
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016495225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist