Provider Demographics
NPI:1598386831
Name:OTERO, FREDDA SURRATT
Entity Type:Individual
Prefix:MRS
First Name:FREDDA
Middle Name:SURRATT
Last Name:OTERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 N FAYETTEVILLE ST STE 202
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-4671
Mailing Address - Country:US
Mailing Address - Phone:336-626-6696
Mailing Address - Fax:336-626-1592
Practice Address - Street 1:610 N FAYETTEVILLE ST STE 202
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-4671
Practice Address - Country:US
Practice Address - Phone:336-626-6696
Practice Address - Fax:336-626-1592
Is Sole Proprietor?:No
Enumeration Date:2020-04-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA3173220174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator