Provider Demographics
NPI:1427337591
Name:FRIEDERICHS, SANDRA LYNN (MOT/L)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:LYNN
Last Name:FRIEDERICHS
Suffix:
Gender:F
Credentials:MOT/L
Other - Prefix:MS
Other - First Name:SANDRA
Other - Middle Name:LYNN
Other - Last Name:WIDMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:4748 S DORY TRL
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86005-8374
Mailing Address - Country:US
Mailing Address - Phone:978-866-9823
Mailing Address - Fax:
Practice Address - Street 1:3285 E SPARROW AVE
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-7794
Practice Address - Country:US
Practice Address - Phone:928-527-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-08
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTH-004729225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics