Provider Demographics
NPI:1861593659
Name:FREVE, ERICA HALCYON (OTR L)
Entity type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:HALCYON
Last Name:FREVE
Suffix:
Gender:F
Credentials:OTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1583 DEER RUN CT
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:NC
Mailing Address - Zip Code:27310-9689
Mailing Address - Country:US
Mailing Address - Phone:207-653-4769
Mailing Address - Fax:
Practice Address - Street 1:1583 DEER RUN CT
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:NC
Practice Address - Zip Code:27310-9689
Practice Address - Country:US
Practice Address - Phone:207-653-4769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8698225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME219030000Medicare ID - Type Unspecified