Provider Demographics
NPI:1891139846
Name:SCIFRES, AMY R
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:R
Last Name:SCIFRES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5571 WALNUT RDG
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-6447
Mailing Address - Country:US
Mailing Address - Phone:217-653-0091
Mailing Address - Fax:
Practice Address - Street 1:5571 WALNUT RDG
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-6447
Practice Address - Country:US
Practice Address - Phone:217-653-0091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005005601225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist