Provider Demographics
NPI:1205657996
Name:COLON, AMY MARTIN (MOTR/L)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:MARTIN
Last Name:COLON
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 ORCHARD LN
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ME
Mailing Address - Zip Code:04258-4264
Mailing Address - Country:US
Mailing Address - Phone:207-595-4178
Mailing Address - Fax:
Practice Address - Street 1:15 STRAWBERRY AVENUE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240
Practice Address - Country:US
Practice Address - Phone:207-520-9329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT1826225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist