Provider Demographics
NPI:1316360779
Name:CHAFFIN, AMY E (PTA)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:E
Last Name:CHAFFIN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 SCHOOL DR
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-2099
Mailing Address - Country:US
Mailing Address - Phone:330-331-0705
Mailing Address - Fax:330-331-0711
Practice Address - Street 1:621 SCHOOL DR
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-2099
Practice Address - Country:US
Practice Address - Phone:330-331-0705
Practice Address - Fax:330-331-0711
Is Sole Proprietor?:No
Enumeration Date:2014-01-21
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH07854225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant