Provider Demographics
NPI:1194074369
Name:FRY, AMY YVONNE (OTR-L)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:YVONNE
Last Name:FRY
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 1:7658 DESIGN RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BAXTER
Mailing Address - State:MN
Mailing Address - Zip Code:56425-8698
Mailing Address - Country:US
Mailing Address - Phone:218-454-4600
Mailing Address - Fax:218-454-4601
Practice Address - Street 1:7658 DESIGN RD
Practice Address - Street 2:SUITE 300
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425-8698
Practice Address - Country:US
Practice Address - Phone:218-454-4600
Practice Address - Fax:218-454-4601
Is Sole Proprietor?:No
Enumeration Date:2012-09-04
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN104320225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist