Basic Information
| Provider Information | |||||||||
| NPI: | 1699947325 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WESTBROCK | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | BETH | ||||||||
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| Credential: | OTR/L, MBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 415 36TH ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | PARKERSBURG | ||||||||
| State: | WV | ||||||||
| PostalCode: | 261011005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3049173660 | ||||||||
| FaxNumber: | 3049173674 | ||||||||
| Practice Location | |||||||||
| Address1: | 2010 GARFIELD AVE | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | PARKERSBURG | ||||||||
| State: | WV | ||||||||
| PostalCode: | 261012527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3049173649 | ||||||||
| FaxNumber: | 3049173651 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2008 | ||||||||
| LastUpdateDate: | 05/27/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 7502088000 | 05 | WV | MEDICAID | 0118936 | 05 | OH | MEDICAID |