Provider Demographics
NPI:1972923399
Name:MCMAHAN, AMANDA JEAN (MS, AT, ATC)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:JEAN
Last Name:MCMAHAN
Suffix:
Gender:F
Credentials:MS, AT, ATC
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:JEAN
Other - Last Name:KOHLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, AT, ATC
Mailing Address - Street 1:100 EAST WASHINGTON STREET
Mailing Address - Street 2:MEDINA HOSPITAL REHAB AND SPORTS THERAPY
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256
Mailing Address - Country:US
Mailing Address - Phone:330-725-1000
Mailing Address - Fax:330-721-4913
Practice Address - Street 1:262 STATE ROUTE 58
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:OH
Practice Address - Zip Code:44880-9762
Practice Address - Country:US
Practice Address - Phone:440-653-1809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-24
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT. 003709283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital