Provider Demographics
NPI:1629629936
Name:HARRIS, AMY (OTR, MSOT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:OTR, MSOT
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:BRANDENSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR, MSOT
Mailing Address - Street 1:3786 GRAY HEATHER LN
Mailing Address - Street 2:
Mailing Address - City:WHITESTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:46075-9786
Mailing Address - Country:US
Mailing Address - Phone:812-319-5749
Mailing Address - Fax:
Practice Address - Street 1:8702 FOUNDERS RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-1337
Practice Address - Country:US
Practice Address - Phone:317-452-9430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-27
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN225X00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician