Provider Demographics
NPI:1992992317
Name:AMMANN, CONNIE BETH (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:BETH
Last Name:AMMANN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6612 DORRINGTON DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-3085
Mailing Address - Country:US
Mailing Address - Phone:910-793-8753
Mailing Address - Fax:
Practice Address - Street 1:4557 TECHNOLOGY DR
Practice Address - Street 2:SUITE 1
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-2171
Practice Address - Country:US
Practice Address - Phone:910-233-0730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-30
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3947225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist