Individual
MRS. AMY BRENNAN TKACZYK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
22 ROLLER COASTER RD, STRAFFORD, NH 03884-6648
(603) 664-2842
Mailing address
30 MILL POND RD, NORTHWOOD, NH 03261-3240
(603) 608-9929
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
0464
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3080893
—
NH
05
—
3080921
—
NH
05
—
3081115
—
NH
Enumeration date
09/02/2020
Last updated
09/02/2020
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