Provider Demographics
NPI:1982196853
Name:FREDERICKS, MADELINE MCCAULEY (OT)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:MCCAULEY
Last Name:FREDERICKS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 BRADLEY ST
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-4406
Mailing Address - Country:US
Mailing Address - Phone:828-412-0908
Mailing Address - Fax:
Practice Address - Street 1:190 BROADWAY ST STE 101
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-2501
Practice Address - Country:US
Practice Address - Phone:828-412-0908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11702225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist