Frederis Ann Henry, COTA/L

Primary specialty

Driving and Community Mobility Occupational Therapy AssistantTaxonomy code 224ZR0403X

License

OP009350 Issued in PA

Practice address

620 Paxton PL Ste 102
Lititz, PA 17543-8279

Phone

(717) 723-8520

NPI assigned

Jun 20, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Frederis Ann Moses Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1560988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560988800000",
    "number": "1225698277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8 SCHOOL LN",
            "city": "STEVENS",
            "state": "PA",
            "postal_code": "175789404",
            "telephone_number": "717-330-8928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 PAXTON PL STE 102",
            "city": "LITITZ",
            "state": "PA",
            "postal_code": "175438279",
            "telephone_number": "717-723-8520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENRY",
        "first_name": "FREDERIS",
        "middle_name": "ANN",
        "credential": "COTA/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-06-20",
        "last_updated": "2019-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224ZR0403X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant, Driving and Community Mobility",
            "state": "PA",
            "license": "OP009350",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COTA",
            "identifier": "OP009350",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "freddie@jcornack.com",
            "affiliation": "N",
            "address_1": "620 Paxton Pl Ste 102",
            "city": "Lititz",
            "state": "PA",
            "country_code": "US",
            "postal_code": "175438279",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "FREDERIS",
            "last_name": "MOSES",
            "middle_name": "ANN",
            "credential": "N/A",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Occupational Therapy Assistant in Lititz, PA
• Providers in Lititz, PA by specialty
• Occupational Therapy Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.