Provider Demographics
NPI:1467588798
Name:RICE, AMANDA RENEE (OTRL)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:RENEE
Last Name:RICE
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7709 ROUTE 474
Mailing Address - Street 2:
Mailing Address - City:PANAMA
Mailing Address - State:NY
Mailing Address - Zip Code:14767-9669
Mailing Address - Country:US
Mailing Address - Phone:716-355-2502
Mailing Address - Fax:
Practice Address - Street 1:715 FALCONER ST
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-1935
Practice Address - Country:US
Practice Address - Phone:716-665-8036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014289-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist