Provider Demographics
NPI:1326313883
Name:NORD, AMANDA MARTHA
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARTHA
Last Name:NORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7403 CHURCHILL ST
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-1902
Mailing Address - Country:US
Mailing Address - Phone:847-414-7675
Mailing Address - Fax:
Practice Address - Street 1:7403 CHURCHILL ST
Practice Address - Street 2:
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-1902
Practice Address - Country:US
Practice Address - Phone:847-414-7675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-16
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist