Active NPI
Brandon Frederking, OTR/L
- Occupational Therapist
- Springdale, AR
National Provider Identifier
1154780229
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OTR2880
- Practice address
- 2070 McKenzie Rd
Suite C
Springdale, AR 72762-0747 - Phone
- (479) 750-7778
- Fax
- (479) 750-7708
- NPI assigned
- Feb 18, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OTR2880 | AR | Primary |
Addresses
Primary practice location
2070 McKenzie Rd
Suite C
Springdale, AR 72762-0747
Mailing address
2915 N 14TH CT
Rogers, AR 72756-2310
Phone (913) 951-1505
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OTR2880 | AR | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jarvis Pediatric Therapy, Inc. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Specialist
- Springdale, AR
- NPI 1467561688
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1455753600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1455753600000",
"number": "1154780229",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2915 N 14TH CT",
"city": "ROGERS",
"state": "AR",
"postal_code": "727562310",
"telephone_number": "913-951-1505"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2070 MCKENZIE RD",
"address_2": "SUITE C",
"city": "SPRINGDALE",
"state": "AR",
"postal_code": "727620747",
"telephone_number": "479-750-7778",
"fax_number": "479-750-7708"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FREDERKING",
"first_name": "BRANDON",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-02-18",
"last_updated": "2016-02-18",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "AR",
"license": "OTR2880",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Springdale, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.