Provider Demographics
NPI:1780729160
Name:ISAKSSON, AMI KIM (OT)
Entity type:Individual
Prefix:
First Name:AMI
Middle Name:KIM
Last Name:ISAKSSON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:AMI
Other - Middle Name:KIM
Other - Last Name:KUEBLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:247 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780-2630
Mailing Address - Country:US
Mailing Address - Phone:631-553-5570
Mailing Address - Fax:631-584-2462
Practice Address - Street 1:252 ISLIP AVE
Practice Address - Street 2:
Practice Address - City:ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11751-3029
Practice Address - Country:US
Practice Address - Phone:631-581-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2017-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008009-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist