Healthcare Provider Details

I. General information

NPI: 1861564536
Provider Name (Legal Business Name): AMY MARIE HUFFINES OTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY MARIE MINAVIK OTA

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 RUSSELL AVE
GAITHERSBURG MD
20877-2805
US

IV. Provider business mailing address

116 MEADOWLARK AVE
MOUNT AIRY MD
21771-5535
US

V. Phone/Fax

Practice location:
  • Phone: 301-216-4247
  • Fax: 301-216-4249
Mailing address:
  • Phone: 301-829-2455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberA01586
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: