Individual
DR. AMY NICOLE UTECHT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTD, MSOT, OTR/L
Contact information
Practice address
2001 PROFESSIONAL PKWY STE 220, WOODSTOCK, GA 30188-6444
(448) 543-8437
(844) 471-3799
Mailing address
709 CRESCENT CIR, CANTON, GA 30115-4772
(678) 462-1342
(678) 493-9464
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT003834
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10035969
AMERIGROUP
GA
01
—
312668
WELLCARE
GA
01
—
490456055A
PEACH STATE HEALTH PLAN
GA
05
—
490456055A
—
GA
05
—
490456055D
—
GA
01
—
52070551 004
BLUE CROSS BLUE SHIELD
GA
01
—
52070551 009
BLUE CROSS BLUE SHIELD
GA
01
—
52070551 010
BLUE CROSS BLUE SHIELD
GA
Enumeration date
11/14/2006
Last updated
07/16/2019
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