Provider Demographics
NPI:1639486012
Name:FREDERIKSEN, SUSAN KATHRYN (OTR/L)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:KATHRYN
Last Name:FREDERIKSEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:KATHRYN
Other - Last Name:PETERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:742 STERBENZ DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-8327
Mailing Address - Country:US
Mailing Address - Phone:715-386-2128
Mailing Address - Fax:715-386-6119
Practice Address - Street 1:742 STERBENZ DR
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-8327
Practice Address - Country:US
Practice Address - Phone:715-386-2128
Practice Address - Fax:715-386-6119
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4908225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist