Provider Demographics
NPI:1871717082
Name:JELLEY, AMY L
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:JELLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:L
Other - Last Name:SCHOOLMASTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19376 PRAIRIE CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46062-6686
Mailing Address - Country:US
Mailing Address - Phone:757-784-4083
Mailing Address - Fax:
Practice Address - Street 1:2141 N DAN JONES RD
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-6023
Practice Address - Country:US
Practice Address - Phone:317-943-1837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119003534225X00000X
IN31006154A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist