Provider Demographics
NPI:1639419856
Name:LISKO, AMANDA JEAN
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JEAN
Last Name:LISKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14346 MANOR CT
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66224-3965
Mailing Address - Country:US
Mailing Address - Phone:785-218-4198
Mailing Address - Fax:
Practice Address - Street 1:14346 MANOR CT
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66224-3965
Practice Address - Country:US
Practice Address - Phone:785-218-4198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113650225X00000X
VA0119005444225X00000X
DCOT010000679225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist