Provider Demographics
NPI:1033319504
Name:ALLEN STEWART, AMANDA (OTR)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:ALLEN STEWART
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1433 GRAND AVENUE PKWY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-2063
Mailing Address - Country:US
Mailing Address - Phone:512-251-3230
Mailing Address - Fax:
Practice Address - Street 1:1433 GRAND AVENUE PKWY
Practice Address - Street 2:SUITE 301
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-2063
Practice Address - Country:US
Practice Address - Phone:512-251-3230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110236225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist