Provider Demographics
NPI:1063077519
Name:CANLER, AMY BETH
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:BETH
Last Name:CANLER
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 1:842 RECTOR AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:KY
Mailing Address - Zip Code:42206-5219
Mailing Address - Country:US
Mailing Address - Phone:270-221-0993
Mailing Address - Fax:
Practice Address - Street 1:842 RECTOR AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:KY
Practice Address - Zip Code:42206-5219
Practice Address - Country:US
Practice Address - Phone:270-221-0993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency