MEDICARE: AMY LEE MUTHERSBAUGH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	DH012843L	PA

General Provider Information

NPI Number	:	1114728433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY LEE MUTHERSBAUGH

Provider Business Mailing Address
First Line	:	62 S GRIMS MILL RD
Second Line	:
City	:	BOYERTOWN
State	:	PA
Zip	:	19512-8548
Country	:	US
Telephone Number	:	484-300-8926
Fax Number	:

Provider Business Practice Location Address
First Line	:	62 S GRIMS MILL RD
Second Line	:
City	:	BOYERTOWN
State	:	PA
Zip	:	19512-8548
Country	:	US
Telephone Number	:	484-300-8926
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2025
Last Update Date	:	03/22/2025

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