Individual
CORY M FREDERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR CLT
Contact information
Practice address
400 WATER AVE, HILLSBORO, WI 54634
(608) 489-8260
(608) 489-8193
Mailing address
E14305 CTY RD P, LAFARGE, WI 54639
(608) 489-3353
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1957026
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40901900
—
WI
01
—
985300
NBCOT
—
Enumeration date
10/16/2006
Last updated
07/08/2007
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