Provider Demographics
NPI:1932475407
Name:FREUDEMAN, RICHARD ALAN (COTA)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALAN
Last Name:FREUDEMAN
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 FOX RUN DR
Mailing Address - Street 2:
Mailing Address - City:MUNROE FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44262-1643
Mailing Address - Country:US
Mailing Address - Phone:330-688-1062
Mailing Address - Fax:
Practice Address - Street 1:19859 ALEXANDER RD
Practice Address - Street 2:
Practice Address - City:WALTON HILLS
Practice Address - State:OH
Practice Address - Zip Code:44146-5345
Practice Address - Country:US
Practice Address - Phone:440-439-4433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA-02792224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant