MEDICARE: SUSAN FRIEDRICH

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	OT17033	FL

General Provider Information

NPI Number	:	1881148757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN FRIEDRICH

Provider Business Mailing Address
First Line	:	3533 CAROLWOOD LN
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32086-4320
Country	:	US
Telephone Number	:	904-315-8525
Fax Number	:	866-480-2125

Provider Business Practice Location Address
First Line	:	3533 CAROLWOOD LN
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32086-4320
Country	:	US
Telephone Number	:	904-315-8525
Fax Number	:	866-480-2125

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

Provider Enumeration Date	:	08/09/2016
Last Update Date	:	08/09/2016

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