Provider Demographics
NPI:1902550494
Name:BARBER, AMY SUZANNE
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:SUZANNE
Last Name:BARBER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 N 1600 EAST RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT AUBURN
Mailing Address - State:IL
Mailing Address - Zip Code:62547-3523
Mailing Address - Country:US
Mailing Address - Phone:217-201-3440
Mailing Address - Fax:
Practice Address - Street 1:3101 N 1600 EAST RD
Practice Address - Street 2:
Practice Address - City:MOUNT AUBURN
Practice Address - State:IL
Practice Address - Zip Code:62547-3523
Practice Address - Country:US
Practice Address - Phone:217-201-3440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057002871224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant