Provider Demographics
NPI:1659586154
Name:SPRAGUE, AMANDA SUZANNE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:SUZANNE
Last Name:SPRAGUE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:SUZANNE
Other - Last Name:SPRAGUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:587 MAIN STREET
Mailing Address - Street 2:SUITE 126
Mailing Address - City:NEW YORK MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:13417
Mailing Address - Country:US
Mailing Address - Phone:315-525-1878
Mailing Address - Fax:315-768-0929
Practice Address - Street 1:587 MAIN STREET
Practice Address - Street 2:SUITE 126
Practice Address - City:NEW YORK MILLS
Practice Address - State:NY
Practice Address - Zip Code:13417
Practice Address - Country:US
Practice Address - Phone:315-525-1878
Practice Address - Fax:315-768-0929
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225700000X
NY015288171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No171W00000XOther Service ProvidersContractor