Provider Demographics
NPI:1457639270
Name:JEFFREY, AMY M (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:M
Last Name:JEFFREY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 RANGE RD
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03087-2379
Mailing Address - Country:US
Mailing Address - Phone:603-548-1200
Mailing Address - Fax:
Practice Address - Street 1:66 NEWTON ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-6058
Practice Address - Country:US
Practice Address - Phone:800-970-5001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-27
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2333314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility