Healthcare Provider Details

I. General information

NPI: 1174296982
Provider Name (Legal Business Name): EMILY LYNNE FRIDBERG OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2021
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 MONTGOMERY AVE STE 307
PENN VALLEY PA
19072-1551
US

IV. Provider business mailing address

506 OAK TER
MERION STATION PA
19066-1341
US

V. Phone/Fax

Practice location:
  • Phone: 302-307-6837
  • Fax:
Mailing address:
  • Phone: 610-420-0966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOC015520
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: