Provider Demographics
NPI:1982985156
Name:FREDERICK, DOROTHY ANN (OT)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:ANN
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5263 GOLDEN GATE PKWY
Mailing Address - Street 2:SUITE E
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34116-7601
Mailing Address - Country:US
Mailing Address - Phone:239-352-9884
Mailing Address - Fax:239-352-9884
Practice Address - Street 1:5263 GOLDEN GATE PKWY
Practice Address - Street 2:SUITE E
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34116-7601
Practice Address - Country:US
Practice Address - Phone:239-352-9884
Practice Address - Fax:239-352-8610
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT1859225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist