Provider Demographics
NPI:1386766699
Name:HAHN, AMY SUE (OTR)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:SUE
Last Name:HAHN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 E WATERFORD ST
Mailing Address - Street 2:
Mailing Address - City:WAKARUSA
Mailing Address - State:IN
Mailing Address - Zip Code:46573-9534
Mailing Address - Country:US
Mailing Address - Phone:574-862-1071
Mailing Address - Fax:
Practice Address - Street 1:1904 S 15TH ST
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-4910
Practice Address - Country:US
Practice Address - Phone:574-537-4034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31002749A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist