Provider Demographics
NPI:1942024997
Name:FREDREGILL, HOPE ANN (COTA/L)
Entity type:Individual
Prefix:
First Name:HOPE
Middle Name:ANN
Last Name:FREDREGILL
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 1:3715 N CENTREPOINT WAY UNIT A107
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-3739
Mailing Address - Country:US
Mailing Address - Phone:503-720-1690
Mailing Address - Fax:
Practice Address - Street 1:10112 W OVERLAND RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-1428
Practice Address - Country:US
Practice Address - Phone:208-495-5401
Practice Address - Fax:208-445-3939
Is Sole Proprietor?:No
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOTA-1509224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant