Provider Demographics
NPI:1538693635
Name:CHILCOTE, AMANDA ANN (OTR/L)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:ANN
Last Name:CHILCOTE
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 1:3605 COOPERS CT APT 16
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49004-7694
Mailing Address - Country:US
Mailing Address - Phone:313-408-4483
Mailing Address - Fax:
Practice Address - Street 1:6330 N FIR RD
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-4753
Practice Address - Country:US
Practice Address - Phone:574-217-0609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-14
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31006336A225X00000X
MI5201009834225X00000X
TX118307225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist