Healthcare Provider Details

I. General information

NPI: 1366507097
Provider Name (Legal Business Name): AMY LYNN FARIA MS OTR L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY ST
PROVIDENCE RI
02903-4923
US

IV. Provider business mailing address

3 CHERRY STREET
TAUNTON MA
02780
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-8661
  • Fax: 404-444-4046
Mailing address:
  • Phone: 508-823-8455
  • Fax: 401-444-4046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT00969
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: