Provider Demographics
NPI:1790530558
Name:NESSELHAUF, AMY (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:NESSELHAUF
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7118 UNDEROAK RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-3915
Mailing Address - Country:US
Mailing Address - Phone:314-779-4952
Mailing Address - Fax:
Practice Address - Street 1:FRIENDSHIP VILLAGE SUNSET HILLS SKILLED NURSING
Practice Address - Street 2:12563 VILLAGE CIR DRIVE
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127
Practice Address - Country:US
Practice Address - Phone:314-270-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004972225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist