Provider Demographics
NPI:1609194893
Name:WHIPPLE, AMANDA L (MS, OTR/L)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:L
Last Name:WHIPPLE
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:MRS
Other - First Name:AMANDA
Other - Middle Name:L
Other - Last Name:MERDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:PO BOX 8080
Mailing Address - Street 2:410 DEWEY STREET
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54495-8080
Mailing Address - Country:US
Mailing Address - Phone:715-424-8500
Mailing Address - Fax:715-424-8502
Practice Address - Street 1:410 DEWEY STREET
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54495-8080
Practice Address - Country:US
Practice Address - Phone:715-424-8500
Practice Address - Fax:715-424-8502
Is Sole Proprietor?:No
Enumeration Date:2010-05-12
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI484326225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist