Provider Demographics
NPI:1174863815
Name:GEORGE, AMANDA MARIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:GEORGE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4111 CANOPY WAY
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-7749
Mailing Address - Country:US
Mailing Address - Phone:540-373-1881
Mailing Address - Fax:
Practice Address - Street 1:6106 HEALTH CENTER LN
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-6687
Practice Address - Country:US
Practice Address - Phone:540-785-1120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-17
Last Update Date:2013-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119003678225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist