Provider Demographics
NPI:1609060482
Name:AVERY, AMYLYNN (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:AMYLYNN
Middle Name:
Last Name:AVERY
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 1:100 SANDY DR
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-8191
Mailing Address - Country:US
Mailing Address - Phone:518-843-3503
Mailing Address - Fax:518-839-0014
Practice Address - Street 1:100 SANDY DR
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-8191
Practice Address - Country:US
Practice Address - Phone:518-843-3503
Practice Address - Fax:518-839-0014
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008934-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist