Provider Demographics
NPI:1063880029
Name:CREAN, AMANDA (MS OTR/L)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:CREAN
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 SEA CLIFF ROAD
Mailing Address - Street 2:
Mailing Address - City:SOUND BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11789
Mailing Address - Country:US
Mailing Address - Phone:631-484-2510
Mailing Address - Fax:
Practice Address - Street 1:12 SEA CLIFF DR
Practice Address - Street 2:
Practice Address - City:SOUND BEACH
Practice Address - State:NY
Practice Address - Zip Code:11789-1849
Practice Address - Country:US
Practice Address - Phone:631-484-2510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-08
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019968-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist