Provider Demographics
NPI:1457471609
Name:FRARY, DEETTE ANN (MS, ATR-BC, LCAT)
Entity Type:Individual
Prefix:MS
First Name:DEETTE
Middle Name:ANN
Last Name:FRARY
Suffix:
Gender:F
Credentials:MS, ATR-BC, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8751 NEW COUNTRY DR APT 5
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039-8359
Mailing Address - Country:US
Mailing Address - Phone:315-657-1505
Mailing Address - Fax:
Practice Address - Street 1:8751 NEW COUNTRY DR
Practice Address - Street 2:APT 5
Practice Address - City:CICERO
Practice Address - State:NY
Practice Address - Zip Code:13039-8641
Practice Address - Country:US
Practice Address - Phone:315-657-1505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000541-1221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist