Provider Demographics
NPI:1639931736
Name:LIKENS, AMY (OTA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:LIKENS
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14201 PARK CENTER DR STE 410
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5251
Mailing Address - Country:US
Mailing Address - Phone:540-545-1055
Mailing Address - Fax:
Practice Address - Street 1:309 WILLOWBROOK RD STE 2
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-3881
Practice Address - Country:US
Practice Address - Phone:301-777-2170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant