Provider Demographics
NPI:1588186241
Name:AMY PARKER THERAPY SERVICES, PLLC
Entity Type:Organization
Organization Name:AMY PARKER THERAPY SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:C
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:850-838-0331
Mailing Address - Street 1:506 NW 526TH ST
Mailing Address - Street 2:
Mailing Address - City:CROSS CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32628-4511
Mailing Address - Country:US
Mailing Address - Phone:850-838-0331
Mailing Address - Fax:
Practice Address - Street 1:506 NW 526TH ST
Practice Address - Street 2:
Practice Address - City:CROSS CITY
Practice Address - State:FL
Practice Address - Zip Code:32628-4511
Practice Address - Country:US
Practice Address - Phone:850-838-0331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
224Z00000X
FLOT11646225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1568536829Medicaid