Healthcare Provider Details

I. General information

NPI: 1770528978
Provider Name (Legal Business Name): AMY LUPARDUS M.S., OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 04/05/2024
Certification Date: 04/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 TRAPPER WAY
BOWLING GREEN KY
42103-7035
US

IV. Provider business mailing address

84 TRAPPER WAY
BOWLING GREEN KY
42103-7035
US

V. Phone/Fax

Practice location:
  • Phone: 229-854-7216
  • Fax:
Mailing address:
  • Phone: 229-854-7216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number4320
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberR5183
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: