Provider Demographics
NPI:1356581755
Name:O'CONNOR, AMY
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 SARAH WELLS TRL
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL HALL
Mailing Address - State:NY
Mailing Address - Zip Code:10916-3351
Mailing Address - Country:US
Mailing Address - Phone:845-496-9279
Mailing Address - Fax:
Practice Address - Street 1:169 SARAH WELLS TRL
Practice Address - Street 2:
Practice Address - City:CAMPBELL HALL
Practice Address - State:NY
Practice Address - Zip Code:10916-3351
Practice Address - Country:US
Practice Address - Phone:845-496-9279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016542235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist