Provider Demographics
NPI:1235655747
Name:DYER, AMANDA (OTL)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:DYER
Suffix:
Gender:F
Credentials:OTL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:752 RICHMOND RD N
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:KY
Mailing Address - Zip Code:40403-1059
Mailing Address - Country:US
Mailing Address - Phone:859-353-3666
Mailing Address - Fax:859-448-7077
Practice Address - Street 1:752 RICHMOND RD N
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:KY
Practice Address - Zip Code:40403-1059
Practice Address - Country:US
Practice Address - Phone:859-353-3666
Practice Address - Fax:859-448-7077
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-16
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist