Provider Demographics
NPI:1306987664
Name:HOWARD, AMANDA BURCH (MSOTRL)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:BURCH
Last Name:HOWARD
Suffix:
Gender:F
Credentials:MSOTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4080 PALMETTO DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1343
Mailing Address - Country:US
Mailing Address - Phone:859-296-6387
Mailing Address - Fax:
Practice Address - Street 1:4080 PALMETTO DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-1343
Practice Address - Country:US
Practice Address - Phone:859-296-6387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR2273225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist