Provider Demographics
NPI:1184047342
Name:FREDERICKS, DEIDRE ANN (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:DEIDRE
Middle Name:ANN
Last Name:FREDERICKS
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 1:2081 LANGHORNE RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-1443
Mailing Address - Country:US
Mailing Address - Phone:434-846-8437
Mailing Address - Fax:434-846-4032
Practice Address - Street 1:2081 LANGHORNE RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-1443
Practice Address - Country:US
Practice Address - Phone:434-846-8437
Practice Address - Fax:434-846-4032
Is Sole Proprietor?:No
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119003703225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology