Provider Demographics
NPI:1073733762
Name:SUMMERS, AMY KATE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:KATE
Last Name:SUMMERS
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 1:1265 LAKE BLUFF CT
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:WI
Mailing Address - Zip Code:53015-1590
Mailing Address - Country:US
Mailing Address - Phone:920-693-8509
Mailing Address - Fax:
Practice Address - Street 1:2629 N 7TH ST
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53083-4932
Practice Address - Country:US
Practice Address - Phone:920-451-5550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1963-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist