Provider Demographics
NPI:1164770343
Name:DERN, AMY JENKINS (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:JENKINS
Last Name:DERN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 GREYSTONE PARC DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-7286
Mailing Address - Country:US
Mailing Address - Phone:205-447-4875
Mailing Address - Fax:
Practice Address - Street 1:1301 GREYSTONE PARC DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-7286
Practice Address - Country:US
Practice Address - Phone:205-447-4875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-20
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics