Provider Demographics
NPI:1033495478
Name:KECKLER, AMANDA J (OTR/L)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:J
Last Name:KECKLER
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 1:1816 KINGS CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-4824
Mailing Address - Country:US
Mailing Address - Phone:724-654-9598
Mailing Address - Fax:
Practice Address - Street 1:1816 KINGS CHAPEL RD
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-4824
Practice Address - Country:US
Practice Address - Phone:724-654-9598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC012074225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist