Provider Demographics
NPI:1437413143
Name:WOLTER, AMY SUSAN
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:SUSAN
Last Name:WOLTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3652 ORANGEPORT RD
Mailing Address - Street 2:
Mailing Address - City:GASPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14067-9316
Mailing Address - Country:US
Mailing Address - Phone:716-946-8767
Mailing Address - Fax:
Practice Address - Street 1:3652 ORANGEPORT RD
Practice Address - Street 2:
Practice Address - City:GASPORT
Practice Address - State:NY
Practice Address - Zip Code:14067-9316
Practice Address - Country:US
Practice Address - Phone:716-946-8767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator