Provider Demographics
NPI:1992122501
Name:ATKINS, AMI BETH (MAT)
Entity type:Individual
Prefix:MRS
First Name:AMI
Middle Name:BETH
Last Name:ATKINS
Suffix:
Gender:F
Credentials:MAT
Other - Prefix:MISS
Other - First Name:AMI
Other - Middle Name:BETH
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MAT
Mailing Address - Street 1:1540 W STONEHENGE DR
Mailing Address - Street 2:1
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-2669
Mailing Address - Country:US
Mailing Address - Phone:864-804-8932
Mailing Address - Fax:
Practice Address - Street 1:1540 W STONEHENGE DR
Practice Address - Street 2:1
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-2669
Practice Address - Country:US
Practice Address - Phone:864-804-8932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-20
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist