Provider Demographics
NPI:1306912597
Name:BOHL, AMY (ATC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:BOHL
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:791 OAK ST
Mailing Address - Street 2:APT 8
Mailing Address - City:PESHTIGO
Mailing Address - State:WI
Mailing Address - Zip Code:54157-1715
Mailing Address - Country:US
Mailing Address - Phone:715-582-0909
Mailing Address - Fax:
Practice Address - Street 1:3117 SHORE DR
Practice Address - Street 2:SUITE 102-103
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-4293
Practice Address - Country:US
Practice Address - Phone:715-732-8200
Practice Address - Fax:715-732-8205
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI451-0392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI451-039OtherWISCONSIN LICENSE