Provider Demographics
NPI:1528624038
Name:AMANDA ANDERSON,OTR/L LLC
Entity type:Organization
Organization Name:AMANDA ANDERSON,OTR/L LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:HALE
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:802-236-8123
Mailing Address - Street 1:162 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-2901
Mailing Address - Country:US
Mailing Address - Phone:802-236-8123
Mailing Address - Fax:802-881-0025
Practice Address - Street 1:162 ADAMS ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-2901
Practice Address - Country:US
Practice Address - Phone:802-236-8123
Practice Address - Fax:802-881-0025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-10
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty