Provider Demographics
NPI:1760615884
Name:HERINGHAUS, AMY (OTR/L, CHT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:HERINGHAUS
Suffix:
Gender:F
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 WESTGATE DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906-2953
Mailing Address - Country:US
Mailing Address - Phone:330-416-6975
Mailing Address - Fax:
Practice Address - Street 1:316 WESTGATE DR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-2953
Practice Address - Country:US
Practice Address - Phone:330-416-6975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT.004824225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand