Provider Demographics
NPI:1619620820
Name:ARNESON, AMANDA JO (MOTR/L)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JO
Last Name:ARNESON
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:AUDUBON
Mailing Address - State:IA
Mailing Address - Zip Code:50025-1426
Mailing Address - Country:US
Mailing Address - Phone:712-304-1290
Mailing Address - Fax:
Practice Address - Street 1:1550 6TH ST
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:IA
Practice Address - Zip Code:51455-1004
Practice Address - Country:US
Practice Address - Phone:712-655-2072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2415225X00000X
IA101540225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist