Provider Demographics
NPI:1215269105
Name:FERNANDES, AMANDA ANNE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:ANNE
Last Name:FERNANDES
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3255 N PAULINA ST UNIT C
Mailing Address - Street 2:UNIT C
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-1014
Mailing Address - Country:US
Mailing Address - Phone:773-868-4769
Mailing Address - Fax:
Practice Address - Street 1:3255 N PAULINA ST
Practice Address - Street 2:UNIT C
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-1014
Practice Address - Country:US
Practice Address - Phone:773-868-4769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.008869225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics