Provider Demographics
NPI:1033758347
Name:DINNEEN, AMANDA J (COTA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:J
Last Name:DINNEEN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:BUDD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:415 S RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NE
Mailing Address - Zip Code:68351-4179
Mailing Address - Country:US
Mailing Address - Phone:402-266-1300
Mailing Address - Fax:
Practice Address - Street 1:2720 17TH AVE
Practice Address - Street 2:
Practice Address - City:CENTRAL CITY
Practice Address - State:NE
Practice Address - Zip Code:68826-9614
Practice Address - Country:US
Practice Address - Phone:308-946-3088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-03
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE431920224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant