Provider Demographics
NPI:1609293224
Name:CUNNINGHAM, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 N WEST SHORE BLVD
Mailing Address - Street 2:600
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-1140
Mailing Address - Country:US
Mailing Address - Phone:800-806-6026
Mailing Address - Fax:
Practice Address - Street 1:255 WATERMAN AVE
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-9530
Practice Address - Country:US
Practice Address - Phone:352-383-0051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-20
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT005614225X00000X
FLOT16167225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist