Provider Demographics
NPI:1528345030
Name:LETSOS, AMANDA S (OTR)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:S
Last Name:LETSOS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4142 VALLEY HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-1953
Mailing Address - Country:US
Mailing Address - Phone:713-254-5541
Mailing Address - Fax:281-441-9081
Practice Address - Street 1:4142 VALLEY HAVEN DR
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-1953
Practice Address - Country:US
Practice Address - Phone:713-254-5541
Practice Address - Fax:281-441-9081
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-11
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104786225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist