Provider Demographics
NPI:1730452608
Name:WEINER, AMY MARIE (COTA/L)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:WEINER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E MC CASKEY
Mailing Address - Street 2:
Mailing Address - City:DUNKIRK
Mailing Address - State:OH
Mailing Address - Zip Code:45836
Mailing Address - Country:US
Mailing Address - Phone:419-581-6821
Mailing Address - Fax:
Practice Address - Street 1:225 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:OH
Practice Address - Zip Code:44875
Practice Address - Country:US
Practice Address - Phone:419-342-2440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH04769172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker