Provider Demographics
NPI:1740545607
Name:FOLKERTS, AMY LOUISE (COTA/L)
Entity type:Individual
Prefix:MISS
First Name:AMY
Middle Name:LOUISE
Last Name:FOLKERTS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 WASHINGTON SQ
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61571-2657
Mailing Address - Country:US
Mailing Address - Phone:309-231-9921
Mailing Address - Fax:
Practice Address - Street 1:128 WASHINGTON SQ
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IL
Practice Address - Zip Code:61571-2657
Practice Address - Country:US
Practice Address - Phone:309-231-9921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-06
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057003005224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant