Provider Demographics
NPI:1093811549
Name:GYDESEN, AMI MARIE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:AMI
Middle Name:MARIE
Last Name:GYDESEN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MISS
Other - First Name:AMI
Other - Middle Name:MARIE
Other - Last Name:DENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:22567 SUMMIT DR BLDG 2
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-7210
Mailing Address - Country:US
Mailing Address - Phone:315-779-6784
Mailing Address - Fax:
Practice Address - Street 1:22567 SUMMIT DR BLDG 2
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-7210
Practice Address - Country:US
Practice Address - Phone:315-779-6784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0058651225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04329911Medicaid