Individual
MISS CARLY RAE FREDETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
997 STAFFORD AVE, STATEN ISLAND, NY 10309-2109
(917) 744-3976
Mailing address
341 E 76TH ST, APT 3RW, NEW YORK, NY 10021-2416
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
63 016863
NY
Other
Enumeration date
09/06/2011
Last updated
09/06/2011
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