Provider Demographics
NPI:1083481477
Name:DUPLESSIS, AMANDA (CTRS)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:DUPLESSIS
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:DUPLESSIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CTRS DUPLESSIS
Mailing Address - Street 1:133 PARK CIR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39212-3834
Mailing Address - Country:US
Mailing Address - Phone:940-331-1457
Mailing Address - Fax:
Practice Address - Street 1:133 PARK CIR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39212-3834
Practice Address - Country:US
Practice Address - Phone:940-331-1457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX85252225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist