Provider Demographics
NPI:1609182617
Name:RICHARDSON, AMANDA MARIE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:MARIE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:MARIE
Other - Last Name:CHOVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:100 BARBER PL
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1863
Mailing Address - Country:US
Mailing Address - Phone:814-453-7661
Mailing Address - Fax:814-874-5505
Practice Address - Street 1:100 BARBER PL
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1863
Practice Address - Country:US
Practice Address - Phone:814-453-7661
Practice Address - Fax:814-874-5505
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC011558225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist