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NPI Code Detail

MEDICARE: JULIE FREDERICK

MEDICARE: JULIE FREDERICK
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1222Q00000XDevelopmental Therapist

General Provider Information

NPI Number : 1336621465
Entity Type Code : Individual
Provider Name (Legal Business Name) : JULIE FREDERICK
Provider Business Mailing Address
First Line : 12213 CARRIAGE STONE DR
Second Line :
City : FISHERS
State : IN
Zip : 46037-8515
Country : US
Telephone Number : 812-219-5426
Fax Number :
Provider Business Practice Location Address
First Line : 10340 PLEASANT ST STE 100
Second Line :
City : NOBLESVILLE
State : IN
Zip : 46060-3947
Country : US
Telephone Number : 812-219-5426
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/05/2018
Last Update Date : 09/05/2018

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Directions to “ JULIE FREDERICK ” Practice Location

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