Provider Demographics
NPI:1316123813
Name:CHOFFIN, AMY SUSAN (MS OTR/L)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:SUSAN
Last Name:CHOFFIN
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10422 BREAMORE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-2511
Mailing Address - Country:US
Mailing Address - Phone:704-846-2627
Mailing Address - Fax:
Practice Address - Street 1:10422 BREAMORE DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28270-2511
Practice Address - Country:US
Practice Address - Phone:704-846-2627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2818172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker