Provider Demographics
NPI:1225565971
Name:OMLOR, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:OMLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19301 SANTA FE LINE RD
Mailing Address - Street 2:
Mailing Address - City:WAYNESFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45896-9424
Mailing Address - Country:US
Mailing Address - Phone:567-204-6790
Mailing Address - Fax:
Practice Address - Street 1:19301 SANTA FE LINE RD
Practice Address - Street 2:
Practice Address - City:WAYNESFIELD
Practice Address - State:OH
Practice Address - Zip Code:45896-9424
Practice Address - Country:US
Practice Address - Phone:567-204-6790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRM419467343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)