Provider Demographics
NPI:1639490253
Name:HARTSELL, AMOS D (OTR/L)
Entity Type:Individual
Prefix:
First Name:AMOS
Middle Name:D
Last Name:HARTSELL
Suffix:
Gender:M
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 1:220 22ND AVE E STE 108
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-4875
Mailing Address - Country:US
Mailing Address - Phone:320-335-2515
Mailing Address - Fax:320-335-2717
Practice Address - Street 1:220 22ND AVE E STE 108
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308
Practice Address - Country:US
Practice Address - Phone:320-335-2515
Practice Address - Fax:320-335-2717
Is Sole Proprietor?:No
Enumeration Date:2010-06-17
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN104047225X00000X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist