Healthcare Provider Details

I. General information

NPI: 1457367435
Provider Name (Legal Business Name): AMY MCCARTY MSOTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 11/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1503 OHIO ST LEAVENWORTH
LEAVENWORTH KS
66048-2932
US

IV. Provider business mailing address

1335 NW BROAD ST MURFEESBORO
MURFREESBORO TN
37129-4428
US

V. Phone/Fax

Practice location:
  • Phone: 913-758-1149
  • Fax: 913-758-1149
Mailing address:
  • Phone: 913-908-5617
  • Fax: 913-728-2122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number17-02367
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: