Provider Demographics
NPI:1548786015
Name:LANGER, AMANDA MARLYS (COTA/L)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARLYS
Last Name:LANGER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 TERRACE ST
Mailing Address - Street 2:
Mailing Address - City:WHITEFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03598-3016
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:MORRISON NURSING HOME
Practice Address - Street 2:6 TERRACE STREET
Practice Address - City:WHITEFIELD
Practice Address - State:NH
Practice Address - Zip Code:03598
Practice Address - Country:US
Practice Address - Phone:603-837-2541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0766224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant