Individual
DALTON FREDERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTD, OTR/L
Contact information
Practice address
6300 E LAKE BLVD STE 101, VANCLEAVE, MS 39565-6771
(228) 215-2240
(228) 215-2241
Mailing address
6300 E LAKE BLVD STE 301, VANCLEAVE, MS 39565-6771
(228) 230-2663
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT-4052
MS
Other
Enumeration date
09/28/2023
Last updated
08/22/2024
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