Provider Demographics
NPI:1851466270
Name:EDER, FREDERICA DAVIS (OT)
Entity Type:Individual
Prefix:MS
First Name:FREDERICA
Middle Name:DAVIS
Last Name:EDER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MISS
Other - First Name:FREDERICA
Other - Middle Name:REYBURN
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:9 CANTWELL ROAD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186
Mailing Address - Country:US
Mailing Address - Phone:617-698-2096
Mailing Address - Fax:
Practice Address - Street 1:1140 DORCHESTER AVE
Practice Address - Street 2:UPHAMS ELDER SERVICE PLAN
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02125
Practice Address - Country:US
Practice Address - Phone:617-288-0970
Practice Address - Fax:617-474-0757
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3640225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist