Provider Demographics
NPI:1396089876
Name:BALDWIN, AMY L (COTA)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 SAINT CHARLES ST
Mailing Address - Street 2:PO BOX 154
Mailing Address - City:MILAN
Mailing Address - State:IN
Mailing Address - Zip Code:47031-0154
Mailing Address - Country:US
Mailing Address - Phone:812-584-0316
Mailing Address - Fax:
Practice Address - Street 1:12803 LENOVER ST
Practice Address - Street 2:
Practice Address - City:DILLSBORO
Practice Address - State:IN
Practice Address - Zip Code:47018-9418
Practice Address - Country:US
Practice Address - Phone:812-432-5226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-21
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32001889A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant