Provider Demographics
NPI:1811428055
Name:PERCHICK, AMY D (OTR/L)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:D
Last Name:PERCHICK
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:PO BOX 7399
Mailing Address - Street 2:PMB 246
Mailing Address - City:BRECKENRIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80424-7399
Mailing Address - Country:US
Mailing Address - Phone:215-530-1167
Mailing Address - Fax:
Practice Address - Street 1:137 GOLD KING WAY
Practice Address - Street 2:
Practice Address - City:BRECKENRIDGE
Practice Address - State:CO
Practice Address - Zip Code:80424-9989
Practice Address - Country:US
Practice Address - Phone:215-530-1167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT0000963225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist