Provider Demographics
NPI:1245575844
Name:MEHNER, AMANDA ARLENE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:ARLENE
Last Name:MEHNER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:ARLENE
Other - Last Name:CARPENTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:612 S WELLS ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:LAKE GENEVA
Mailing Address - State:WI
Mailing Address - Zip Code:53147-2159
Mailing Address - Country:US
Mailing Address - Phone:262-248-8177
Mailing Address - Fax:262-248-6393
Practice Address - Street 1:612 S WELLS ST
Practice Address - Street 2:SUITE C
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147-2159
Practice Address - Country:US
Practice Address - Phone:262-248-8177
Practice Address - Fax:262-248-6393
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-07
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10312-146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist