Provider Demographics
NPI:1760164362
Name:MONTIETH, AMANDA RACHAE
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:RACHAE
Last Name:MONTIETH
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 1:178 MILL RUN RD LOT 142
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:OH
Mailing Address - Zip Code:45690-8811
Mailing Address - Country:US
Mailing Address - Phone:740-577-6291
Mailing Address - Fax:
Practice Address - Street 1:178 MILL RUN RD LOT 142
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:OH
Practice Address - Zip Code:45690-8811
Practice Address - Country:US
Practice Address - Phone:740-577-6291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide