Provider Demographics
NPI:1083448559
Name:PERRY, AMY CHRISTINE
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:CHRISTINE
Last Name:PERRY
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 1:10 N OAKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:KENOVA
Mailing Address - State:WV
Mailing Address - Zip Code:25530-1907
Mailing Address - Country:US
Mailing Address - Phone:304-638-1550
Mailing Address - Fax:
Practice Address - Street 1:10 N OAKVIEW DR
Practice Address - Street 2:
Practice Address - City:KENOVA
Practice Address - State:WV
Practice Address - Zip Code:25530-1907
Practice Address - Country:US
Practice Address - Phone:304-638-1550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-28
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251300000X
WV364455252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251300000XAgenciesLocal Education Agency (LEA)