Provider Demographics
NPI:1144761065
Name:FILL, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:FILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:LEITZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS OTR/L
Mailing Address - Street 1:6826 WELBURY ST
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-3171
Mailing Address - Country:US
Mailing Address - Phone:269-569-6539
Mailing Address - Fax:
Practice Address - Street 1:7855 CURRIER DR
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-4314
Practice Address - Country:US
Practice Address - Phone:269-323-7748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-10
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201007802225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist