Provider Demographics
NPI:1215276886
Name:PHIPPS, AMY MICHELLE (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:MICHELLE
Last Name:PHIPPS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5041 RARDEN HAZELBAKER RD
Mailing Address - Street 2:
Mailing Address - City:OTWAY
Mailing Address - State:OH
Mailing Address - Zip Code:45657-8952
Mailing Address - Country:US
Mailing Address - Phone:740-372-6040
Mailing Address - Fax:
Practice Address - Street 1:5041 RARDEN HAZELBAKER RD
Practice Address - Street 2:
Practice Address - City:OTWAY
Practice Address - State:OH
Practice Address - Zip Code:45657-8952
Practice Address - Country:US
Practice Address - Phone:740-372-6040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-02
Last Update Date:2013-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA 03299224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant