Provider Demographics
NPI:1700892486
Name:GOTTESMAN, AMY B (OTRL, CHT)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:B
Last Name:GOTTESMAN
Suffix:
Gender:F
Credentials:OTRL, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 WESTCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:PURCHASE
Mailing Address - State:NY
Mailing Address - Zip Code:10577-2547
Mailing Address - Country:US
Mailing Address - Phone:914-607-5730
Mailing Address - Fax:914-457-1195
Practice Address - Street 1:1281 E MAIN ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-3544
Practice Address - Country:US
Practice Address - Phone:203-210-2840
Practice Address - Fax:203-210-2841
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002535225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTPENDINGMedicaid
796864OtherCONNECTICUT
2992437OtherAETNA
CV7563OtherGUARDIAN
2273938OtherUNITED HEALTHCARE
CV7563OtherHEALTH NET
P2695487OtherOXFORD
CV7563OtherHEALTH NET