Provider Demographics
NPI:1689129124
Name:STEWART, AMY MARIE (MS, CTRS, CBIS, CCM)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:STEWART
Suffix:
Gender:F
Credentials:MS, CTRS, CBIS, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2672 E BOMBAY RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-7379
Mailing Address - Country:US
Mailing Address - Phone:517-304-5184
Mailing Address - Fax:
Practice Address - Street 1:2672 E BOMBAY RD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48642-7379
Practice Address - Country:US
Practice Address - Phone:517-304-5184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
4220542171M00000X
49039225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator