Provider Demographics
NPI:1912966359
Name:FRIGM, SUE A (OTL)
Entity Type:Individual
Prefix:MRS
First Name:SUE
Middle Name:A
Last Name:FRIGM
Suffix:
Gender:F
Credentials:OTL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3917 RIDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17404
Mailing Address - Country:US
Mailing Address - Phone:717-840-4178
Mailing Address - Fax:
Practice Address - Street 1:40 W 11TH AVE
Practice Address - Street 2:STE A
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17404
Practice Address - Country:US
Practice Address - Phone:717-852-7733
Practice Address - Fax:717-852-7503
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC003134L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA396830Medicare ID - Type Unspecified