Provider Demographics
NPI:1811013477
Name:AYCOCK, AMY HUBER (OTR)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:HUBER
Last Name:AYCOCK
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 SARAZEN DR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27527-3922
Mailing Address - Country:US
Mailing Address - Phone:919-553-0972
Mailing Address - Fax:919-550-7695
Practice Address - Street 1:935 SHOTWELL RD
Practice Address - Street 2:SUITE 103
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-5595
Practice Address - Country:US
Practice Address - Phone:919-359-0589
Practice Address - Fax:919-550-7695
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1468225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7301046Medicaid
NC1173XOtherBCBS