Healthcare Provider Details

I. General information

NPI: 1629369509
Provider Name (Legal Business Name): KRISTIN ANNE FREDMONSKY OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2011
Last Update Date: 04/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224D EGLIN PKWY NE
FORT WALTON BEACH FL
32547-2877
US

IV. Provider business mailing address

224D EGLIN PKWY NE
FORT WALTON BEACH FL
32547-2877
US

V. Phone/Fax

Practice location:
  • Phone: 850-862-7227
  • Fax: 850-862-2421
Mailing address:
  • Phone: 850-862-7227
  • Fax: 850-862-2421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT 14520
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: