Provider Demographics
NPI:1821429796
Name:INGOLD, AMANDA (ATC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:INGOLD
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7774 DAYTON SPRINGFIELD RD
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-1957
Mailing Address - Country:US
Mailing Address - Phone:937-340-6488
Mailing Address - Fax:937-340-6512
Practice Address - Street 1:7774 DAYTON SPRINGFIELD RD
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-1957
Practice Address - Country:US
Practice Address - Phone:937-340-6488
Practice Address - Fax:937-340-6512
Is Sole Proprietor?:No
Enumeration Date:2013-12-03
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0032202255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer