Healthcare Provider Details

I. General information

NPI: 1205745114
Provider Name (Legal Business Name): MICHAEL AMENT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9333 W LINCOLN AVE
WEST ALLIS WI
53227-2303
US

IV. Provider business mailing address

1355 PIONEER TRL
WAUKESHA WI
53186-2305
US

V. Phone/Fax

Practice location:
  • Phone: 414-604-3001
  • Fax:
Mailing address:
  • Phone: 262-370-4831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number364326
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: