Healthcare Provider Details

I. General information

NPI: 1740581495
Provider Name (Legal Business Name): AMY MARIE EHRHARDT LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2010
Last Update Date: 11/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 WARSAW ST
DEPEW NY
14043-3916
US

IV. Provider business mailing address

400 EXCHANGE ST
ALDEN NY
14004-9309
US

V. Phone/Fax

Practice location:
  • Phone: 716-348-7434
  • Fax:
Mailing address:
  • Phone: 716-348-7434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number021191-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: