Provider Demographics
NPI:1609272830
Name:SPADE, AMY (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:SPADE
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1047 BLACK BEAR RD
Mailing Address - Street 2:
Mailing Address - City:NEEDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:17238-8877
Mailing Address - Country:US
Mailing Address - Phone:724-549-1644
Mailing Address - Fax:
Practice Address - Street 1:1047 BLACK BEAR RD
Practice Address - Street 2:
Practice Address - City:NEEDMORE
Practice Address - State:PA
Practice Address - Zip Code:17238-8877
Practice Address - Country:US
Practice Address - Phone:724-549-1644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC011659225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist