Healthcare Provider Details

I. General information

NPI: 1164511861
Provider Name (Legal Business Name): AMY SUE YAPLE LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 01/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 RIVER RD STE 1
N TONAWANDA NY
14120-6563
US

IV. Provider business mailing address

603 DIVISION ST.
NORTH TONAWANDA NY
14120
US

V. Phone/Fax

Practice location:
  • Phone: 716-693-2464
  • Fax: 716-693-9022
Mailing address:
  • Phone: 716-692-2160
  • Fax: 716-332-3658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number016599
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: