Provider Demographics
NPI:1619612058
Name:CUNNINGHAM, FREDERICA (OTR/L)
Entity Type:Individual
Prefix:
First Name:FREDERICA
Middle Name:
Last Name:CUNNINGHAM
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 1:1753 MARTIN LUTHER KING BLVD
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:SC
Mailing Address - Zip Code:29061-9613
Mailing Address - Country:US
Mailing Address - Phone:803-479-8073
Mailing Address - Fax:
Practice Address - Street 1:1753 MARTIN LUTHER KING BLVD
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:SC
Practice Address - Zip Code:29061-9613
Practice Address - Country:US
Practice Address - Phone:803-479-8073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-30
Last Update Date:2022-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6508225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist