Provider Demographics
NPI:1124248554
Name:PIERCE, AMY (MS OTR L)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:PIERCE
Suffix:
Gender:F
Credentials:MS OTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 PETTIS RD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-3349
Mailing Address - Country:US
Mailing Address - Phone:907-250-0651
Mailing Address - Fax:907-339-2335
Practice Address - Street 1:320 PETTIS RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-3349
Practice Address - Country:US
Practice Address - Phone:907-250-0651
Practice Address - Fax:907-339-2335
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKOT 1019225X00000X
AKOT1019225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist