Provider Demographics
NPI:1356555700
Name:ADKISSON, AMY CATHERINE (MPS, ATR-BC)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:CATHERINE
Last Name:ADKISSON
Suffix:
Gender:F
Credentials:MPS, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 ROYAL ST
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35213-2130
Mailing Address - Country:US
Mailing Address - Phone:205-879-0363
Mailing Address - Fax:
Practice Address - Street 1:626 ROYAL ST
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35213-2130
Practice Address - Country:US
Practice Address - Phone:205-879-0363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL04-164221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL04-164OtherART THERAPY REGISTRATION