Provider Demographics
NPI:1598975369
Name:KRZESZEWSKI, AMY L (OTR/L)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:KRZESZEWSKI
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1519 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-4844
Mailing Address - Country:US
Mailing Address - Phone:814-490-6118
Mailing Address - Fax:
Practice Address - Street 1:1519 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-4844
Practice Address - Country:US
Practice Address - Phone:814-490-6118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6243225X00000X
NM2534225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist