Provider Demographics
NPI:1821273889
Name:PERRY, AMANDA M (OTRL)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:M
Last Name:PERRY
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 419
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-4602
Mailing Address - Country:US
Mailing Address - Phone:610-356-7355
Mailing Address - Fax:610-355-7649
Practice Address - Street 1:10 WEST PLEASANT GROVE ROAD
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-7110
Practice Address - Country:US
Practice Address - Phone:610-356-7355
Practice Address - Fax:610-355-7649
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC009912225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1019126430001Medicaid