Provider Demographics
NPI:1750558730
Name:JAMESON, AMY (OT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:JAMESON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2602 HIGHWAY 28 E STE A
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-5609
Mailing Address - Country:US
Mailing Address - Phone:318-443-9305
Mailing Address - Fax:318-443-3143
Practice Address - Street 1:2602 HIGHWAY 28 E STE A
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-5609
Practice Address - Country:US
Practice Address - Phone:318-443-9305
Practice Address - Fax:318-443-3143
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200014225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist