Provider Demographics
NPI:1104155811
Name:LAWRENCE, AMY ELLEN (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:ELLEN
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-2417
Mailing Address - Country:US
Mailing Address - Phone:304-205-7290
Mailing Address - Fax:
Practice Address - Street 1:113 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25313-1467
Practice Address - Country:US
Practice Address - Phone:304-342-9515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1276225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation