Healthcare Provider Details

I. General information

NPI: 1629570411
Provider Name (Legal Business Name): AMY MARIE BURGESS SWT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2018
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5726 SOUTHWYCK BLVD STE 200
TOLEDO OH
43614-1510
US

IV. Provider business mailing address

5726 SOUTHWYCK BLVD STE 200
TOLEDO OH
43614-1510
US

V. Phone/Fax

Practice location:
  • Phone: 419-214-1766
  • Fax: 419-214-1792
Mailing address:
  • Phone: 419-214-1766
  • Fax: 419-214-1792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberS2604868
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: