Provider Demographics
NPI:1447237987
Name:WELIKY, AMY BETH (OT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:BETH
Last Name:WELIKY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:538 MISSION ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-3036
Mailing Address - Country:US
Mailing Address - Phone:626-403-1444
Mailing Address - Fax:626-628-3905
Practice Address - Street 1:538 MISSION ST
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-3036
Practice Address - Country:US
Practice Address - Phone:626-403-1444
Practice Address - Fax:626-628-3905
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 1220174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW13096Medicare ID - Type UnspecifiedGROUP