Provider Demographics
NPI:1447601919
Name:OTTERBEIN, AMY (PT)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:OTTERBEIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:206 PAGE AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-2418
Mailing Address - Country:US
Mailing Address - Phone:517-783-6670
Mailing Address - Fax:517-783-5310
Practice Address - Street 1:865 OLDS ST
Practice Address - Street 2:SUITE D4
Practice Address - City:JONESVILLE
Practice Address - State:MI
Practice Address - Zip Code:49250-9478
Practice Address - Country:US
Practice Address - Phone:517-849-7040
Practice Address - Fax:517-849-7050
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501002187225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist