Provider Demographics
NPI:1023509445
Name:BACK, AMANDA (RBT)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:BACK
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:OBERLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:326 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-3004
Mailing Address - Country:US
Mailing Address - Phone:937-450-4566
Mailing Address - Fax:
Practice Address - Street 1:1750 COMMERCE CENTER BLVD
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-6333
Practice Address - Country:US
Practice Address - Phone:937-878-8444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-21
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician