Provider Demographics
NPI:1356643274
Name:OTIS, AMY JO (RN)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:JO
Last Name:OTIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:JO
Other - Last Name:KOVACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:550 BUCKMAN RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14615-1251
Mailing Address - Country:US
Mailing Address - Phone:585-966-5905
Mailing Address - Fax:585-581-8181
Practice Address - Street 1:550 BUCKMAN RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14615-1251
Practice Address - Country:US
Practice Address - Phone:585-966-5905
Practice Address - Fax:585-581-8181
Is Sole Proprietor?:No
Enumeration Date:2010-11-29
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY605226-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool