Provider Demographics
NPI:1366403651
Name:CONNOR, AMY BETH (OTR/L)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:BETH
Last Name:CONNOR
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 92
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:NC
Mailing Address - Zip Code:28519-0092
Mailing Address - Country:US
Mailing Address - Phone:252-497-5241
Mailing Address - Fax:252-672-9201
Practice Address - Street 1:2619 TRENT RD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2025
Practice Address - Country:US
Practice Address - Phone:252-497-5241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2024-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5387225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1382KOtherBC
NC7301792Medicaid
NC1382KOtherBC