Provider Demographics
NPI:1063632602
Name:DIMARCO, AMY E (OTR)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:E
Last Name:DIMARCO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 W 109TH TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-4989
Mailing Address - Country:US
Mailing Address - Phone:816-942-6602
Mailing Address - Fax:
Practice Address - Street 1:25 W 109TH TER
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4989
Practice Address - Country:US
Practice Address - Phone:816-942-6602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-00935305S00000X, 311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered305S00000XManaged Care OrganizationsPoint of Service
Not Answered311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS17-00935OtherOCCUPATIONAL THERAPY
KS17-00935OtherOCCUPATIONAL THERAPIST