Provider Demographics
NPI:1689176588
Name:BELCHER, AMANDA (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:BELCHER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 E VIERTHALER ST
Mailing Address - Street 2:
Mailing Address - City:SPEARVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67876-8807
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-2760
Practice Address - Country:US
Practice Address - Phone:620-682-4059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS18-01489224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant