Provider Demographics
NPI:1467743385
Name:ADAMS, AMANDA GAIL (OTR)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:GAIL
Last Name:ADAMS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 HENDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:TX
Mailing Address - Zip Code:77630-6325
Mailing Address - Country:US
Mailing Address - Phone:409-877-1091
Mailing Address - Fax:409-877-1092
Practice Address - Street 1:807 HENDERSON AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:TX
Practice Address - Zip Code:77630-6325
Practice Address - Country:US
Practice Address - Phone:409-877-1091
Practice Address - Fax:409-877-1092
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114089225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149984001Medicaid
TX207164901Medicaid
TX456606Medicare PIN
TX676535Medicare PIN