Individual
MRS. LORI GRIMES FREDERICKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.O.T.R
Contact information
Practice address
3940 PRESCOTT RD, BATON ROUGE, LA 70805-5143
(225) 355-4461
(225) 355-4488
Mailing address
5833 MOURNING DOVE DR, BATON ROUGE, LA 70817-1101
(225) 753-8777
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
Z10414
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1317802
—
LA
Enumeration date
04/17/2007
Last updated
07/09/2007
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