Provider Demographics
NPI:1033600747
Name:TARLTON, AMANDA (OTRL)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:TARLTON
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80060 HOLMES RD
Mailing Address - Street 2:
Mailing Address - City:ARMADA
Mailing Address - State:MI
Mailing Address - Zip Code:48005-1117
Mailing Address - Country:US
Mailing Address - Phone:586-883-3634
Mailing Address - Fax:
Practice Address - Street 1:12150 30 MILE RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48095-2035
Practice Address - Country:US
Practice Address - Phone:313-461-9402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201005772225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist