Provider Demographics
NPI:1164685509
Name:CHESTNUT, AMANDA HOPE (MS, OTR)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:HOPE
Last Name:CHESTNUT
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 61122
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-8122
Mailing Address - Country:US
Mailing Address - Phone:720-261-3549
Mailing Address - Fax:
Practice Address - Street 1:2057 VINE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-5647
Practice Address - Country:US
Practice Address - Phone:720-261-3549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO227676225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist