Provider Demographics
NPI:1316112907
Name:GRIFFITH, AMY LYNN (OTR/L)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:GRIFFITH
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 1:173 PATTON DR
Mailing Address - Street 2:
Mailing Address - City:BETHALTO
Mailing Address - State:IL
Mailing Address - Zip Code:62010-2288
Mailing Address - Country:US
Mailing Address - Phone:618-377-6188
Mailing Address - Fax:618-377-6188
Practice Address - Street 1:173 PATTON DR
Practice Address - Street 2:
Practice Address - City:BETHALTO
Practice Address - State:IL
Practice Address - Zip Code:62010-2288
Practice Address - Country:US
Practice Address - Phone:618-377-6188
Practice Address - Fax:618-377-6188
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.005343225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist