Provider Demographics
NPI:1063680270
Name:WAGENFELD, AMY (PHD, OTR/L)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:
Last Name:WAGENFELD
Suffix:
Gender:F
Credentials:PHD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 WAVERLEY OAKS RD
Mailing Address - Street 2:BLDG 3, STE 305
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02452-8448
Mailing Address - Country:US
Mailing Address - Phone:781-894-6564
Mailing Address - Fax:781-893-5938
Practice Address - Street 1:411 WAVERLEY OAKS RD
Practice Address - Street 2:BLDG 3, STE 305
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02452-8448
Practice Address - Country:US
Practice Address - Phone:781-894-6564
Practice Address - Fax:781-893-5938
Is Sole Proprietor?:No
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6408225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist