Provider Demographics
NPI:1891191714
Name:NEUROHR, AMANDA (OTR, ATC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:NEUROHR
Suffix:
Gender:F
Credentials:OTR, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 MILL ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:IL
Mailing Address - Zip Code:61373-9402
Mailing Address - Country:US
Mailing Address - Phone:815-830-4717
Mailing Address - Fax:
Practice Address - Street 1:600 E 1ST ST
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:IL
Practice Address - Zip Code:61362-1512
Practice Address - Country:US
Practice Address - Phone:815-223-5346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-05
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960030172255A2300X
IL056.011267225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer