Provider Demographics
NPI:1700902277
Name:FRY, MANDY SUE (OTRL)
Entity Type:Individual
Prefix:
First Name:MANDY
Middle Name:SUE
Last Name:FRY
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3483 CARDINAL DR
Mailing Address - Street 2:
Mailing Address - City:SHARPSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16150-9237
Mailing Address - Country:US
Mailing Address - Phone:724-866-5353
Mailing Address - Fax:724-962-2019
Practice Address - Street 1:3483 CARDINAL DR
Practice Address - Street 2:
Practice Address - City:SHARPSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16150-9237
Practice Address - Country:US
Practice Address - Phone:724-866-5353
Practice Address - Fax:724-962-2019
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC006950L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist