Provider Demographics
NPI:1093886616
Name:STRADLING, AMANDA LYNN (L M T)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LYNN
Last Name:STRADLING
Suffix:
Gender:F
Credentials:L M T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 N MAGNOLIA AVE
Mailing Address - Street 2:SUITE 216
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34475-6604
Mailing Address - Country:US
Mailing Address - Phone:352-351-2987
Mailing Address - Fax:
Practice Address - Street 1:108 N MAGNOLIA AVE
Practice Address - Street 2:SUITE 216
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34475-6604
Practice Address - Country:US
Practice Address - Phone:352-351-2987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL47851225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist