Provider Demographics
NPI:1265097547
Name:CALZOLANO, AMANDA NICOLE (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:NICOLE
Last Name:CALZOLANO
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 CARRIAGE LN
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-3603
Mailing Address - Country:US
Mailing Address - Phone:516-712-5058
Mailing Address - Fax:
Practice Address - Street 1:165 S MCCASLIN BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027
Practice Address - Country:US
Practice Address - Phone:303-604-6441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0005881225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist