Provider Demographics
NPI:1285978866
Name:BOETTNER, AMY KRISTEN (MOTR/L)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:KRISTEN
Last Name:BOETTNER
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13467 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-1258
Mailing Address - Country:US
Mailing Address - Phone:419-250-8759
Mailing Address - Fax:
Practice Address - Street 1:5224 BAYSHORE RD
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-4404
Practice Address - Country:US
Practice Address - Phone:419-698-8003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-20
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT 006209225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist