Provider Demographics
NPI:1255495057
Name:KEMNETZ, AMANDA JOANNE (MOT,OTRL)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JOANNE
Last Name:KEMNETZ
Suffix:
Gender:F
Credentials:MOT,OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 E JOLIET ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-2054
Mailing Address - Country:US
Mailing Address - Phone:219-979-2735
Mailing Address - Fax:219-865-1311
Practice Address - Street 1:586 WILLIAM LATHAM DR
Practice Address - Street 2:SUITE 6A
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-2327
Practice Address - Country:US
Practice Address - Phone:815-932-0381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056-006344225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics