Provider Demographics
NPI:1003121054
Name:STURM, AMANDA E (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:E
Last Name:STURM
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:E
Other - Last Name:HARTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3235 OLIVET CHURCH RD STE D
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-9545
Mailing Address - Country:US
Mailing Address - Phone:270-556-3933
Mailing Address - Fax:
Practice Address - Street 1:3235 OLIVET CHURCH RD STE D
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-9545
Practice Address - Country:US
Practice Address - Phone:270-443-5712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-14
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY131969225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100145730Medicaid
KY131969OtherKENTUCKY BOARD OF LICENSURE FOR OCCUPATIONAL THERAPY