Provider Demographics
NPI:1053527044
Name:STAFFORD, AMY
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 INDUSTRIAL DR UNIT 1
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03087-2014
Mailing Address - Country:US
Mailing Address - Phone:603-870-0078
Mailing Address - Fax:
Practice Address - Street 1:3 INDUSTRIAL DR UNIT 1
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:NH
Practice Address - Zip Code:03087-2014
Practice Address - Country:US
Practice Address - Phone:603-870-0078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1560225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH13Y004021NH01OtherANTHEM
NH4126960OtherMVP HEALTHCARE