Active NPI
Amy Jo Hathaway, OTRL
- Occupational Therapist
- Bradford, PA
National Provider Identifier
1073709705
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OC008580
- Practice address
- 110 Campus Drive
Bradford, PA 16701 - Phone
- (814) 362-6535
- Fax
- (814) 887-5666
- NPI assigned
- Sep 17, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OC008580 | PA | Primary |
Addresses
Primary practice location
110 Campus Drive
Bradford, PA 16701
Mailing address
65 Sunrise Ridge Rd
Coudersport, PA 16915
Phone (814) 274-2255
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0019314300003 | Medicaid | PA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OC008580 | PA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1189987200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1189987200000",
"number": "1073709705",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "65 SUNRISE RIDGE RD",
"city": "COUDERSPORT",
"state": "PA",
"postal_code": "16915",
"telephone_number": "814-274-2255"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 CAMPUS DRIVE",
"city": "BRADFORD",
"state": "PA",
"postal_code": "16701",
"telephone_number": "814-362-6535",
"fax_number": "814-887-5666"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HATHAWAY",
"first_name": "AMY",
"middle_name": "JO",
"name_prefix": "Mrs.",
"credential": "OTRL",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-09-17",
"last_updated": "2007-09-17",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "PA",
"license": "OC008580",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0019314300003",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bradford, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.