Healthcare Provider Details

I. General information

NPI: 1457183030
Provider Name (Legal Business Name): AMY BARON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2024
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 SPRINGFIELD ST
DAYTON OH
45431-1084
US

IV. Provider business mailing address

4801 SPRINGFIELD ST
DAYTON OH
45431-1084
US

V. Phone/Fax

Practice location:
  • Phone: 937-236-9965
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT009968
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: