Provider Demographics
NPI:1043630668
Name:MA, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:MA
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 1:200 ROUTE 108
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SOMERSWORTH
Mailing Address - State:NH
Mailing Address - Zip Code:03878-1119
Mailing Address - Country:US
Mailing Address - Phone:603-742-7492
Mailing Address - Fax:603-742-6762
Practice Address - Street 1:7 MARSH BROOK DR
Practice Address - Street 2:SUITE 101
Practice Address - City:SOMERSWORTH
Practice Address - State:NH
Practice Address - Zip Code:03878-6523
Practice Address - Country:US
Practice Address - Phone:603-749-6686
Practice Address - Fax:603-750-3174
Is Sole Proprietor?:No
Enumeration Date:2014-04-22
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2364225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist