Provider Demographics
NPI:1962796912
Name:FRIED, SANDRA (OTR/L)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:FRIED
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:SANDI
Other - Middle Name:
Other - Last Name:FRIED
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1403 GRAYSTONE CANYON AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89183-6306
Mailing Address - Country:US
Mailing Address - Phone:702-768-0368
Mailing Address - Fax:
Practice Address - Street 1:1403 GRAYSTONE CANYON AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89183-6306
Practice Address - Country:US
Practice Address - Phone:702-768-0368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0036225X00000X
CA10111225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist