Provider Demographics
NPI:1205292950
Name:HARTLEY, AMANDA (MOT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:HARTLEY
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 W WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:POSTVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52162-7786
Mailing Address - Country:US
Mailing Address - Phone:563-451-2714
Mailing Address - Fax:
Practice Address - Street 1:112 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:IA
Practice Address - Zip Code:52175-1022
Practice Address - Country:US
Practice Address - Phone:563-422-3811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA079970225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist