Provider Demographics
NPI:1912384777
Name:SPEIGHTS, AMANDA (DHSC, OTR/L)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:
Last Name:SPEIGHTS
Suffix:
Gender:F
Credentials:DHSC, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17690 SW 107TH AVE APT 104
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-0828
Mailing Address - Country:US
Mailing Address - Phone:305-457-5551
Mailing Address - Fax:
Practice Address - Street 1:17690 SW 107TH AVE APT 104
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-0828
Practice Address - Country:US
Practice Address - Phone:305-457-5551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-30
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
FLOT 16986.225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015212000Medicaid