Individual
JAMES FREDERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
1919 CHARMONT DR, CHARLESTON, AR 72933-8910
(479) 965-6752
Mailing address
1504 CHARMONT DR, CHARLESTON, AR 72933-9071
(479) 965-3455
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OT2015-007
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
207085721
—
AR
Enumeration date
04/24/2015
Last updated
04/24/2015
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