Provider Demographics
NPI:1508213604
Name:MASTERS, AMY (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:MASTERS
Suffix:
Gender:F
Credentials:OTD, OTR/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 WATERFRONT RD LOT 16
Mailing Address - Street 2:
Mailing Address - City:HUBERT
Mailing Address - State:NC
Mailing Address - Zip Code:28539-4377
Mailing Address - Country:US
Mailing Address - Phone:503-507-5186
Mailing Address - Fax:
Practice Address - Street 1:280 SWANSBORO LOOP RD
Practice Address - Street 2:
Practice Address - City:SWANSBORO
Practice Address - State:NC
Practice Address - Zip Code:28584-8686
Practice Address - Country:US
Practice Address - Phone:503-507-5186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-18
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR21762174400000X, 225700000X
NC16153225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No174400000XOther Service ProvidersSpecialist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist