Healthcare Provider Details

I. General information

NPI: 1083161145
Provider Name (Legal Business Name): AMY ELIZABETH VILLALOBOS OT/R
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 04/29/2021
Certification Date: 04/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 CONVERSE CIR
EAST LONGMEADOW MA
01028-1906
US

IV. Provider business mailing address

16 CONVERSE CIR
EAST LONGMEADOW MA
01028-1906
US

V. Phone/Fax

Practice location:
  • Phone: 413-847-1212
  • Fax:
Mailing address:
  • Phone: 413-847-1212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number12191
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number16542658
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number900839666
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number12191
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: