Provider Demographics
NPI:1437322260
Name:SNIPES, AMANDA ROYAL (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:ROYAL
Last Name:SNIPES
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 HOLLAND TRACE CIR
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-5869
Mailing Address - Country:US
Mailing Address - Phone:864-982-0607
Mailing Address - Fax:
Practice Address - Street 1:127 HOLLAND TRACE CIR
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-5869
Practice Address - Country:US
Practice Address - Phone:864-982-0607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-13
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3149225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH1945Medicaid