MEDICARE: EDWARD LOUIS FRYE OTRL

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
1	225X00000X	Occupational Therapist	OT00000792	WA

General Provider Information

NPI Number	:	1740482512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD LOUIS FRYE OTRL

Provider Business Mailing Address
First Line	:	PO BOX 66571
Second Line	:
City	:	BURIEN
State	:	WA
Zip	:	98166-0571
Country	:	US
Telephone Number	:	206-910-5767
Fax Number	:	206-320-9257

Provider Business Practice Location Address
First Line	:	6601 220TH ST SW
Second Line	:	SUITE 1
City	:	MOUNTLAKE TERRACE
State	:	WA
Zip	:	98043-2166
Country	:	US
Telephone Number	:	425-775-7274
Fax Number	:	425-775-0963

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2007
Last Update Date	:	07/08/2007

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