Provider Demographics
NPI:1881356053
Name:TRUDEAU, AMY MARIE (MSOT OTRL)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:MARIE
Last Name:TRUDEAU
Suffix:
Gender:F
Credentials:MSOT OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5868 TODY RD
Mailing Address - Street 2:
Mailing Address - City:GOODRICH
Mailing Address - State:MI
Mailing Address - Zip Code:48438-9620
Mailing Address - Country:US
Mailing Address - Phone:810-577-2121
Mailing Address - Fax:
Practice Address - Street 1:2413 S LINDEN RD STE B
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-5455
Practice Address - Country:US
Practice Address - Phone:810-733-3911
Practice Address - Fax:810-733-3912
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201011113225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist