Provider Demographics
NPI:1740005842
Name:MALONEY, AMANDA (OTR, OTD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:MALONEY
Suffix:
Gender:F
Credentials:OTR, OTD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:MALONEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR, OTD
Mailing Address - Street 1:934 HEDGE APPLE DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-2876
Mailing Address - Country:US
Mailing Address - Phone:702-843-3993
Mailing Address - Fax:
Practice Address - Street 1:BLDG 3219 47TH ST & KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:FORT CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223
Practice Address - Country:US
Practice Address - Phone:270-461-3894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist