Provider Demographics
NPI:1407543879
Name:BEINHORN, AMANDA JEAN (COTA/L)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JEAN
Last Name:BEINHORN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:AJ
Other - Middle Name:JEAN
Other - Last Name:BEINHORN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTA/L
Mailing Address - Street 1:2168 GRANITE DR
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-2977
Mailing Address - Country:US
Mailing Address - Phone:612-916-2442
Mailing Address - Fax:
Practice Address - Street 1:2168 GRANITE DR
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-2977
Practice Address - Country:US
Practice Address - Phone:612-916-2442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN202394224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant