Provider Demographics
NPI:1912373572
Name:MCCUSKER, AMANDA (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:MCCUSKER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:CARDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:2362 BUCK VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:WARFORDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17267-8139
Mailing Address - Country:US
Mailing Address - Phone:540-686-6570
Mailing Address - Fax:
Practice Address - Street 1:110 LAUCK DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22603-4282
Practice Address - Country:US
Practice Address - Phone:540-667-7830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131001074224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant