Provider Demographics
NPI:1235827841
Name:HAYCISAK, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:HAYCISAK
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 1:1513 FAIRLANE RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERHILL
Mailing Address - State:PA
Mailing Address - Zip Code:15958-5007
Mailing Address - Country:US
Mailing Address - Phone:814-241-4829
Mailing Address - Fax:
Practice Address - Street 1:1513 FAIRLANE RD
Practice Address - Street 2:
Practice Address - City:SUMMERHILL
Practice Address - State:PA
Practice Address - Zip Code:15958-5007
Practice Address - Country:US
Practice Address - Phone:814-241-4829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC010150225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist