Provider Demographics
NPI:1770512139
Name:ANDERSON, AMY LYNNE (OTR/L)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LYNNE
Last Name:ANDERSON
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 1:17 HOLLY BUSH LN
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2436
Mailing Address - Country:US
Mailing Address - Phone:860-889-1232
Mailing Address - Fax:
Practice Address - Street 1:111 OLD SALEM RD
Practice Address - Street 2:BOCC-REHAB SERVICES
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-6439
Practice Address - Country:US
Practice Address - Phone:860-823-6317
Practice Address - Fax:860-823-6540
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002095225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist