Provider Demographics
NPI:1902026487
Name:STICKLIN, AMY
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:
Last Name:STICKLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:MARIE
Other - Last Name:STICKLIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 11867
Mailing Address - Street 2:CMS - CCS
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93775-1867
Mailing Address - Country:US
Mailing Address - Phone:559-600-3229
Mailing Address - Fax:559-445-2772
Practice Address - Street 1:1221 FULTON MALL
Practice Address - Street 2:CMS - CCS
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-1915
Practice Address - Country:US
Practice Address - Phone:559-600-3229
Practice Address - Fax:559-445-2772
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23829225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist