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NPI Code Detail

MEDICARE: AMY YVONNE FRY OTR-L

MEDICARE: AMY YVONNE FRY OTR-L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist104320MN

General Provider Information

NPI Number : 1194074369
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY YVONNE FRY OTR-L
Provider Business Mailing Address
First Line : 804 OAK ST
Second Line :
City : BRAINERD
State : MN
Zip : 56401-3755
Country : US
Telephone Number : 218-454-5500
Fax Number : 218-454-2148
Provider Business Practice Location Address
First Line : 804 OAK ST
Second Line :
City : BRAINERD
State : MN
Zip : 56401-3755
Country : US
Telephone Number : 218-454-5500
Fax Number : 218-454-2148
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/04/2012
Last Update Date : 03/17/2026

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