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NPI Code Detail

MEDICARE: DESIREE FREDERICKS

MEDICARE: DESIREE FREDERICKS
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
1224P00000XProsthetist
2222Z00000XOrthotist952667855WA

General Provider Information

NPI Number : 1700365152
Entity Type Code : Individual
Provider Name (Legal Business Name) : DESIREE FREDERICKS
Provider Business Mailing Address
First Line : 723 MARTIN LUTHER KING JR WAY
Second Line :
City : TACOMA
State : WA
Zip : 98405-4139
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 723 MARTIN LUTHER KING JR WAY
Second Line :
City : TACOMA
State : WA
Zip : 98405-4139
Country : US
Telephone Number : 253-383-4447
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/07/2018
Last Update Date : 08/07/2018

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Directions to “ DESIREE FREDERICKS ” Practice Location

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