Provider Demographics
NPI:1336430222
Name:UNDERWOOD, AMY FRANCES (OTR/L)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:FRANCES
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:BRENNAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:226 TERRITORIAL RD
Mailing Address - Street 2:
Mailing Address - City:BENTON HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:49022-3436
Mailing Address - Country:US
Mailing Address - Phone:773-677-8921
Mailing Address - Fax:
Practice Address - Street 1:2251 E EUCLID AVE
Practice Address - Street 2:
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-9210
Practice Address - Country:US
Practice Address - Phone:773-677-8921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-26
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201009379225XP0019X
IL056009168225X00000X
HI1198225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist