Provider Demographics
NPI:1174369144
Name:GASSAWAY, AMY LANE (IECE CERTIFIED)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LANE
Last Name:GASSAWAY
Suffix:
Gender:F
Credentials:IECE CERTIFIED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 WHITE DOGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-7536
Mailing Address - Country:US
Mailing Address - Phone:270-799-8662
Mailing Address - Fax:877-442-1027
Practice Address - Street 1:303 WHITE DOGWOOD DR
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-7536
Practice Address - Country:US
Practice Address - Phone:270-799-8662
Practice Address - Fax:877-442-1027
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist