Provider Demographics
NPI:1316395536
Name:AMANDA LANGDON THERAPY, LLC
Entity type:Organization
Organization Name:AMANDA LANGDON THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGDON
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:606-813-2211
Mailing Address - Street 1:222 PLEASANT RUN EST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40962-8114
Mailing Address - Country:US
Mailing Address - Phone:606-813-2211
Mailing Address - Fax:
Practice Address - Street 1:222 PLEASANT RUN EST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40962-8114
Practice Address - Country:US
Practice Address - Phone:606-813-2211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY131912252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency