Provider Demographics
NPI:1922162577
Name:BREDEMEIER, AMANDA SUE (OT)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:SUE
Last Name:BREDEMEIER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 OREGON ST
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:KS
Mailing Address - Zip Code:66434-2232
Mailing Address - Country:US
Mailing Address - Phone:785-742-7606
Mailing Address - Fax:785-742-4490
Practice Address - Street 1:700 OREGON ST
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:KS
Practice Address - Zip Code:66434-2232
Practice Address - Country:US
Practice Address - Phone:785-742-7606
Practice Address - Fax:785-742-4490
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-01981225X00000X
NE1120225X00000X
MO2007017527225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS012507004Medicare PIN