Provider Demographics
NPI:1932083862
Name:FREDERICK-FULTON, CINDY (COTA/L)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:FREDERICK-FULTON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15550 ROUTE 422 HWY E
Mailing Address - Street 2:
Mailing Address - City:STRONGSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15957-9408
Mailing Address - Country:US
Mailing Address - Phone:814-961-4018
Mailing Address - Fax:
Practice Address - Street 1:15574 ROUTE 422 HWY E
Practice Address - Street 2:
Practice Address - City:STRONGSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15957-9408
Practice Address - Country:US
Practice Address - Phone:814-961-4018
Practice Address - Fax:814-961-4018
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP002430L224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant