Healthcare Provider Details

I. General information

NPI: 1912966359
Provider Name (Legal Business Name): SUE A FRIGM OTL
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 W 11TH AVE STE A
YORK PA
17404
US

IV. Provider business mailing address

3917 RIDGEWOOD RD
YORK PA
17404
US

V. Phone/Fax

Practice location:
  • Phone: 717-852-7733
  • Fax: 717-852-7503
Mailing address:
  • Phone: 717-840-4178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC003134L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: