Provider Demographics
NPI:1770600702
Name:PETERSON, AMY LYNN (OTR)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:PETERSON
Suffix:
Gender:
Credentials:OTR
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:LYNN
Other - Last Name:BUDTKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1000 N OAK AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-5702
Mailing Address - Country:US
Mailing Address - Phone:715-387-5511
Mailing Address - Fax:
Practice Address - Street 1:1000 N OAK AVE
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:WI
Practice Address - Zip Code:54449
Practice Address - Country:US
Practice Address - Phone:715-387-5511
Practice Address - Fax:715-389-0781
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2352225X00000X
WI4781225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist