Provider Demographics
NPI:1689836561
Name:BUMGARNER, AMY W (OTR/L)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:W
Last Name:BUMGARNER
Suffix:
Gender:F
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 1:561 N POLK ST
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28134-8563
Mailing Address - Country:US
Mailing Address - Phone:704-889-7828
Mailing Address - Fax:704-889-7832
Practice Address - Street 1:561 N POLK ST
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28134-8563
Practice Address - Country:US
Practice Address - Phone:704-889-7828
Practice Address - Fax:704-889-7832
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6674225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist