Healthcare Provider Details

I. General information

NPI: 1275934903
Provider Name (Legal Business Name): AMY MIZER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2014
Last Update Date: 09/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

499 E WEISHEIMER RD
COLUMBUS OH
43214-2238
US

IV. Provider business mailing address

1739 HARRISON POND DR
NEW ALBANY OH
43054-8885
US

V. Phone/Fax

Practice location:
  • Phone: 614-365-8134
  • Fax:
Mailing address:
  • Phone: 614-216-0509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT.003683
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: