Provider Demographics
NPI:1366829657
Name:NIEHAUS, AMANDA (MOTR/L)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:NIEHAUS
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6881 NE 2ND LOOP
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34470-2227
Mailing Address - Country:US
Mailing Address - Phone:727-871-3216
Mailing Address - Fax:
Practice Address - Street 1:6881 NE 2ND LOOP
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-2227
Practice Address - Country:US
Practice Address - Phone:727-871-3216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16968225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist