Provider Demographics
NPI:1891838868
Name:LANGDON, AMANDA M (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:M
Last Name:LANGDON
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 1:222 PLEASANT RUN EST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40962-8114
Mailing Address - Country:US
Mailing Address - Phone:606-813-2211
Mailing Address - Fax:
Practice Address - Street 1:222 PLEASANT RUN EST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40962-8114
Practice Address - Country:US
Practice Address - Phone:606-813-2211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-R2436225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist