Provider Demographics
NPI:1962816116
Name:FARMER, AMY MARIE (DT)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:MARIE
Last Name:FARMER
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2506 BUXTON DR
Mailing Address - Street 2:APT 116
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938-9293
Mailing Address - Country:US
Mailing Address - Phone:217-317-1587
Mailing Address - Fax:
Practice Address - Street 1:7704 DEERPATH RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:IL
Practice Address - Zip Code:61920-8735
Practice Address - Country:US
Practice Address - Phone:217-508-7171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist