Amy Lynn Booth, DAILY LIVING AIDE
Individual provider Active NPI Contractor · Fresno, OH
NPI 1285648014 · NPPES record last updated Apr 29, 2008
Key facts
- NPI
- 1285648014
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- License
- SD472594 (OH)
- Practice address
- 51505 Township Road 224
Fresno, OH 43824-9028 - Phone
- (740) 545-5288
- NPI assigned
- Jul 28, 2006
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SD472594 | OH | MD | Contractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | SD472594 | OH | Yes |
Addresses
Primary practice location
51505 Township Road 224
Fresno, OH 43824-9028
Mailing address
51505 Township Road 224
Fresno, OH 43824-9028
Phone (740) 545-5288
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2589551 | Medicaid | OH |
Other providers in Fresno, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 29, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.