Provider Demographics
NPI:1356686505
Name:BULLION, AMY SUE (COTA/L)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:SUE
Last Name:BULLION
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MILLS PLACE
Mailing Address - Street 2:
Mailing Address - City:NEW LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45345
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 MILLS PL
Practice Address - Street 2:
Practice Address - City:NEW LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45345-1430
Practice Address - Country:US
Practice Address - Phone:937-687-1311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA.04264224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant