Provider Demographics
NPI:1689914574
Name:KOVERMAN, AMANDA (OTR/L)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:KOVERMAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 KULP RD
Mailing Address - Street 2:
Mailing Address - City:MINFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45653-8847
Mailing Address - Country:US
Mailing Address - Phone:740-821-4239
Mailing Address - Fax:
Practice Address - Street 1:252 KULP RD
Practice Address - Street 2:
Practice Address - City:MINFORD
Practice Address - State:OH
Practice Address - Zip Code:45653-8847
Practice Address - Country:US
Practice Address - Phone:740-821-4239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH-005205225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist