Provider Demographics
NPI:1366864472
Name:WHEADON, AMY (MS, OTR/L)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:
Last Name:WHEADON
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 GARDEN ST UNIT 1A
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-1430
Mailing Address - Country:US
Mailing Address - Phone:978-777-1122
Mailing Address - Fax:978-777-2007
Practice Address - Street 1:27 GARDEN ST UNIT 1A
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-1430
Practice Address - Country:US
Practice Address - Phone:978-777-1122
Practice Address - Fax:978-777-2007
Is Sole Proprietor?:No
Enumeration Date:2014-01-08
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7585225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics