Provider Demographics
NPI:1528429610
Name:DANICK, AMY (MS OTR/L)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:DANICK
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 1:149 RESERVOIR RD
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02170-3612
Mailing Address - Country:US
Mailing Address - Phone:617-797-3022
Mailing Address - Fax:
Practice Address - Street 1:500 GRANITE AVE
Practice Address - Street 2:SUITE ONE
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-5626
Practice Address - Country:US
Practice Address - Phone:617-797-3022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8736174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist