Provider Demographics
NPI:1609907484
Name:UTENDORF, AMY KRISTINE (ATC)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:KRISTINE
Last Name:UTENDORF
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:11196 FAIRVIEW DR
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:OH
Mailing Address - Zip Code:45875-9732
Mailing Address - Country:US
Mailing Address - Phone:419-523-3783
Mailing Address - Fax:419-523-6323
Practice Address - Street 1:1331 E 4TH ST
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:OH
Practice Address - Zip Code:45875-1545
Practice Address - Country:US
Practice Address - Phone:419-523-9337
Practice Address - Fax:419-523-6323
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT-6442255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer