Provider Demographics
NPI:1265875868
Name:IADEROSA, AMANDA (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:IADEROSA
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6901 S YOSEMITE ST STE 208
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-1488
Mailing Address - Country:US
Mailing Address - Phone:248-470-3192
Mailing Address - Fax:
Practice Address - Street 1:6901 S YOSEMITE ST STE 208
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-1488
Practice Address - Country:US
Practice Address - Phone:248-470-3192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-12
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0004459225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics