Provider Demographics
NPI:1427362169
Name:FREDERICK, DANICA (OTR/L)
Entity type:Individual
Prefix:
First Name:DANICA
Middle Name:
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 STATE ST STE 3A
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-1850
Mailing Address - Country:US
Mailing Address - Phone:207-667-4413
Mailing Address - Fax:207-667-6493
Practice Address - Street 1:248 STATE ST STE 3A
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-1850
Practice Address - Country:US
Practice Address - Phone:207-667-4413
Practice Address - Fax:207-667-6493
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT1154225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist