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General NPI Number Information
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NPI Number | 1417676461
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Entity Type | Individual
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Provider Name | SHREDERICK CHARLES KING JR. OTR/L
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Gender | Male
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Dates
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Enumeration Date | 08/23/2022
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Last Update Date | 08/23/2022
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Provider Practice Location Address
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Address Line | 345 S HALCYON RD
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City | ARROYO GRANDE
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State | CA
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Zip | 93420-3817
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Country | US
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Telephone | 844-885-9903
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Fax |
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Provider Business Mailing Address
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Address Line | 655 S WILLOW ST STE 128
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City | MANCHESTER
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State | NH
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Zip | 03103-5723
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 122377
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 328007
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 23906
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License Number State | CA
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