Individual
MRS. AMY EASTERLY NISTICO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.O.T.
Contact information
Practice address
815 NW 9TH ST, SUITE180, CORVALLIS, OR 97330-6173
(541) 768-5157
Mailing address
PO BOX 1189, CORVALLIS, OR 97339-1189
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
105826
OR
Other
Enumeration date
05/03/2007
Last updated
11/11/2020
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