Provider Demographics
NPI:1477693422
Name:LOESCH, AMY LYNN (OTRL)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:LYNN
Last Name:LOESCH
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3930 SWARTHMORE RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-5314
Mailing Address - Country:US
Mailing Address - Phone:919-489-1251
Mailing Address - Fax:
Practice Address - Street 1:3930 SWARTHMORE RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-5314
Practice Address - Country:US
Practice Address - Phone:919-321-2183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4316225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics