Healthcare Provider Details

I. General information

NPI: 1801270954
Provider Name (Legal Business Name): AMY SONNTAG OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2015
Last Update Date: 07/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5268 NICHOLSON LN SUITE A
KENSINGTON MD
20895-1009
US

IV. Provider business mailing address

PO BOX 283
FREDERICK MD
21705-0283
US

V. Phone/Fax

Practice location:
  • Phone: 301-770-5437
  • Fax: 301-668-7008
Mailing address:
  • Phone: 240-397-6750
  • Fax: 301-668-7008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number07704
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: