Basic Information
| Provider Information | |||||||||
| NPI: | 1992205603 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FRIDDELL | ||||||||
| FirstName: | ANDREA | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3829 ROYAL BLVD | ||||||||
| Address2: | |||||||||
| City: | LYNCHBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245032455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8048145494 | ||||||||
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| Practice Location | |||||||||
| Address1: | 235 EVERGREEN AVE | ||||||||
| Address2: | |||||||||
| City: | APPOMATTOX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245224501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4343527420 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/19/2018 | ||||||||
| LastUpdateDate: | 06/16/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 0119-007348 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 0019-007348 | 01 | VA | OT LICENSE | OTHER |