1144501735 NPI number — MRS. AMY SUZANNE CLAUS O.T.R./L

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144501735 NPI number — MRS. AMY SUZANNE CLAUS O.T.R./L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLAUS
Provider First Name:
AMY
Provider Middle Name:
SUZANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
O.T.R./L
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WOLIN
Provider Other First Name:
AMY
Provider Other Middle Name:
SUZANNE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
OTR/L
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1144501735
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/31/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1136 S. SHORE ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HADLEY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12835
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-312-0887
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
WSWHE BOCES
Provider Second Line Business Practice Location Address:
15 HENNIG ROAD
Provider Business Practice Location Address City Name:
SARATOGA SPRINGS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12866
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-581-3605
Provider Business Practice Location Address Fax Number:
518-581-3844
Provider Enumeration Date:
09/08/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XP0200X , with the licence number: 005433-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 776 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1144501735 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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