Provider Demographics
NPI:1598381485
Name:SALEM, AMANDA (MT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:SALEM
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6962 BRITWELL LN
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-4072
Mailing Address - Country:US
Mailing Address - Phone:614-619-5789
Mailing Address - Fax:
Practice Address - Street 1:6962 BRITWELL LN
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-4072
Practice Address - Country:US
Practice Address - Phone:614-619-5789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-17
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty