Provider Demographics
NPI:1770775645
Name:WOOD, AMY JAYNE (ATC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:JAYNE
Last Name:WOOD
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3466 S 82ND ST
Mailing Address - Street 2:APT 8
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-3373
Mailing Address - Country:US
Mailing Address - Phone:402-660-0774
Mailing Address - Fax:
Practice Address - Street 1:8303 DODGE STREET-HPER
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68182
Practice Address - Country:US
Practice Address - Phone:402-554-3170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2152255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer