Provider Demographics
NPI:1518397546
Name:CHAMPION, AMANDA (M ED)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:CHAMPION
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 CROSSWINDS DR
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33413-2001
Mailing Address - Country:US
Mailing Address - Phone:407-489-5638
Mailing Address - Fax:
Practice Address - Street 1:106 CROSSWINDS DR
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33413-2001
Practice Address - Country:US
Practice Address - Phone:407-489-5638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-12
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist