Provider Demographics
NPI:1003313420
Name:HOSS, AMANDA MERCEDES (OTR/L)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MERCEDES
Last Name:HOSS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7834 CROSSWATER TRL APT 3208
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-9493
Mailing Address - Country:US
Mailing Address - Phone:561-267-2594
Mailing Address - Fax:
Practice Address - Street 1:7380 W SAND LAKE RD STE 500
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5257
Practice Address - Country:US
Practice Address - Phone:407-905-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19036225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist