Provider Demographics
NPI:1740551704
Name:WIDNER, AMIE MARGARET (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:AMIE
Middle Name:MARGARET
Last Name:WIDNER
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 CREEKWOOD CV
Mailing Address - Street 2:
Mailing Address - City:MORRILTON
Mailing Address - State:AR
Mailing Address - Zip Code:72110-8809
Mailing Address - Country:US
Mailing Address - Phone:501-208-3326
Mailing Address - Fax:
Practice Address - Street 1:26 CREEKWOOD CV
Practice Address - Street 2:
Practice Address - City:MORRILTON
Practice Address - State:AR
Practice Address - Zip Code:72110-8809
Practice Address - Country:US
Practice Address - Phone:501-208-3326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR2332225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist