Provider Demographics
NPI:1669603429
Name:NOLAN, AMY MARIE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:MARIE
Last Name:NOLAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:24806 KENNEDY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-3469
Mailing Address - Country:US
Mailing Address - Phone:216-225-0149
Mailing Address - Fax:216-901-2803
Practice Address - Street 1:5520 BROADVIEW RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-1605
Practice Address - Country:US
Practice Address - Phone:216-749-6650
Practice Address - Fax:216-749-1655
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-28
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT005376225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3158461Medicaid
OH000000603850OtherANTHEM BLUE CROSS AND BLUE SHEILD
OH12075740OtherCAQH