Provider Demographics
NPI:1356696124
Name:SPILMAN, AMY L (OT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:SPILMAN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:L
Other - Last Name:STALLINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:PO BOX 5629
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47716-5629
Mailing Address - Country:US
Mailing Address - Phone:812-759-7475
Mailing Address - Fax:812-773-6365
Practice Address - Street 1:225 CROSSLAKE DR
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715
Practice Address - Country:US
Practice Address - Phone:812-477-1558
Practice Address - Fax:812-474-2296
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31005325A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000780115OtherBLUE CROSS BLUE SHIELD
IN000000780585OtherBLUE CROSS BLUE SHIELD
IN201113200Medicaid
IN000000780031OtherBLUE CROSS BLUE SHIELD
IN255480002Medicare UPIN
IN201113200Medicaid
IN000000780115OtherBLUE CROSS BLUE SHIELD