Provider Demographics
NPI:1932971173
Name:FREY, LYDIA KRISTINE (OTR/L)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:KRISTINE
Last Name:FREY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:LYDIA
Other - Middle Name:KRISTINE
Other - Last Name:KREEGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1104 W CRUMLEY ST
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-4026
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1615 E ROWLAND AVE
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91791-1250
Practice Address - Country:US
Practice Address - Phone:626-627-1121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25603225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist