Provider Demographics
NPI:1104156223
Name:CULLEN, AMY CATHERINE (OTR/L)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:CATHERINE
Last Name:CULLEN
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 1:1235 POTOMAC AVE SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-4115
Mailing Address - Country:US
Mailing Address - Phone:703-309-7732
Mailing Address - Fax:
Practice Address - Street 1:1235 POTOMAC AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-4115
Practice Address - Country:US
Practice Address - Phone:703-309-7732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-12
Last Update Date:2012-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCOT010000561225XP0200X
VA0119004658225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics