Provider Demographics
NPI:1063711091
Name:ANSARA, AMY EMILY (OTR/L)
Entity type:Individual
Prefix:MISS
First Name:AMY
Middle Name:EMILY
Last Name:ANSARA
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 1:42615 GARFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1653
Mailing Address - Country:US
Mailing Address - Phone:586-412-2845
Mailing Address - Fax:586-412-7087
Practice Address - Street 1:1432 E 12 MILE RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-2651
Practice Address - Country:US
Practice Address - Phone:248-543-4886
Practice Address - Fax:248-543-0479
Is Sole Proprietor?:No
Enumeration Date:2011-03-16
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201007924225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist