Individual
REVA K FREDERICKSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
5120 S 98TH CT, APT 12, OMAHA, NE 68127-5600
(402) 639-1795
Mailing address
5120 S 98TH CT, APT 12, OMAHA, NE 68127-5600
(402) 639-1795
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
400
NE
Other
Enumeration date
09/20/2006
Last updated
07/08/2007
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