Provider Demographics
NPI:1548454911
Name:WARDWELL, AMY A (LMT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:A
Last Name:WARDWELL
Suffix:
Gender:F
Credentials:LMT
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Mailing Address - Street 1:3357 JENNY LIND RD
Mailing Address - Street 2:
Mailing Address - City:AMELIA
Mailing Address - State:OH
Mailing Address - Zip Code:45102-1848
Mailing Address - Country:US
Mailing Address - Phone:513-752-1663
Mailing Address - Fax:513-752-7728
Practice Address - Street 1:8595 BEECHMONT AVE STE 200
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-4740
Practice Address - Country:US
Practice Address - Phone:513-752-1663
Practice Address - Fax:513-752-7728
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-29
Last Update Date:2023-03-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH33-00-7407225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist