Provider Demographics
NPI:1376811075
Name:BAUMGARTNER, AMY P (OT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:P
Last Name:BAUMGARTNER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4048 MASSEY HOLT RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NC
Mailing Address - Zip Code:27569-8965
Mailing Address - Country:US
Mailing Address - Phone:919-936-3345
Mailing Address - Fax:
Practice Address - Street 1:1214 PARKWAY DR
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-3448
Practice Address - Country:US
Practice Address - Phone:919-739-0047
Practice Address - Fax:919-739-9041
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC4000225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics