Provider Demographics
NPI:1619390929
Name:WEST, AMY (ORT/L)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:WEST
Suffix:
Gender:F
Credentials:ORT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5350 W NEW MARKET RD
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45133-7722
Mailing Address - Country:US
Mailing Address - Phone:937-393-1904
Mailing Address - Fax:937-393-1904
Practice Address - Street 1:5350 W NEW MARKET RD
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133-7722
Practice Address - Country:US
Practice Address - Phone:937-393-1904
Practice Address - Fax:937-393-1904
Is Sole Proprietor?:No
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5888225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist