Provider Demographics
NPI:1891815239
Name:WOLCHESKI, AMY BLAKE (OTR L)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:BLAKE
Last Name:WOLCHESKI
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 1:52 HILL AVE
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-2256
Mailing Address - Country:US
Mailing Address - Phone:203-284-8282
Mailing Address - Fax:
Practice Address - Street 1:52 HILL AVE
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-2256
Practice Address - Country:US
Practice Address - Phone:203-284-8282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002279225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics