Provider Demographics
NPI:1356669493
Name:LESTER, AMY (DT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:LESTER
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 WABASH AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62220-3370
Mailing Address - Country:US
Mailing Address - Phone:618-234-6876
Mailing Address - Fax:618-234-6150
Practice Address - Street 1:1306 WABASH AVE
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62220-3370
Practice Address - Country:US
Practice Address - Phone:618-234-6876
Practice Address - Fax:618-234-6150
Is Sole Proprietor?:No
Enumeration Date:2010-05-13
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist