Provider Demographics
NPI:1306115878
Name:GILMORE, AMY MARIE
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:GILMORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 WHEAT STREET
Mailing Address - Street 2:
Mailing Address - City:CAYUGA
Mailing Address - State:NY
Mailing Address - Zip Code:13034-1234
Mailing Address - Country:US
Mailing Address - Phone:315-889-4170
Mailing Address - Fax:315-889-4175
Practice Address - Street 1:255 WHEAT STREET
Practice Address - Street 2:
Practice Address - City:CAYUGA
Practice Address - State:NY
Practice Address - Zip Code:13034-1234
Practice Address - Country:US
Practice Address - Phone:315-889-4170
Practice Address - Fax:315-889-4175
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist