Provider Demographics
NPI:1689825002
Name:FREDERICKS, KRISTEN M (MOTR/L)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:M
Last Name:FREDERICKS
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 PIONEER DR
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-6418
Mailing Address - Country:US
Mailing Address - Phone:215-284-8116
Mailing Address - Fax:
Practice Address - Street 1:113 PIONEER DR
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-6418
Practice Address - Country:US
Practice Address - Phone:215-284-8116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-03
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC009563225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist