Provider Demographics
NPI:1982725123
Name:AMELSE, JAMIE
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:AMELSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 W OAK LEAF DR UNIT 7
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-4458
Mailing Address - Country:US
Mailing Address - Phone:414-510-6553
Mailing Address - Fax:
Practice Address - Street 1:200 N FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1861
Practice Address - Country:US
Practice Address - Phone:847-996-6666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant