Provider Demographics
NPI:1003182569
Name:MCCLELLAN, AMY M
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:MCCLELLAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 S 20TH AVE W
Mailing Address - Street 2:SUITE A
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55806-3526
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:114 S 20TH AVE W
Practice Address - Street 2:SUITE A
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55806-3526
Practice Address - Country:US
Practice Address - Phone:218-721-4732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant