Provider Demographics
NPI:1831604214
Name:BASTIAN, AMY (OTR)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:BASTIAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 N. PROSPECT AVE THERAPY DEPARTMENT
Mailing Address - Street 2:JEWISH HOME & CARE CENTER
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-3018
Mailing Address - Country:US
Mailing Address - Phone:414-277-8846
Mailing Address - Fax:414-277-8803
Practice Address - Street 1:1414 N. PROSPECT AVE THERAPY DEPARTMENT
Practice Address - Street 2:JEWISH HOME & CARE CENTER
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-3018
Practice Address - Country:US
Practice Address - Phone:414-277-8846
Practice Address - Fax:414-277-8803
Is Sole Proprietor?:No
Enumeration Date:2017-12-07
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6168-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist