Provider Demographics
NPI:1023135647
Name:TERSTRIEP, AMANDA (OT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:TERSTRIEP
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 1:409 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IL
Mailing Address - Zip Code:62298-1110
Mailing Address - Country:US
Mailing Address - Phone:217-316-2419
Mailing Address - Fax:888-452-2930
Practice Address - Street 1:634 N MAIN ST
Practice Address - Street 2:SUITE 5
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-3746
Practice Address - Country:US
Practice Address - Phone:618-690-0068
Practice Address - Fax:888-452-2930
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056008002225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist