Provider Demographics
NPI:1497872758
Name:DWYER, AMY ELIZABETH (OTR)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:ELIZABETH
Last Name:DWYER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 EMBDEN POND RD
Mailing Address - Street 2:
Mailing Address - City:NORTH ANSON
Mailing Address - State:ME
Mailing Address - Zip Code:04958-7418
Mailing Address - Country:US
Mailing Address - Phone:207-474-9686
Mailing Address - Fax:
Practice Address - Street 1:23 CEDAR RIDGE DR
Practice Address - Street 2:
Practice Address - City:SKOWHEGAN
Practice Address - State:ME
Practice Address - Zip Code:04976-4160
Practice Address - Country:US
Practice Address - Phone:207-474-9686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT1300225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist