Provider Demographics
NPI:1750425120
Name:PYATT, AMANDA C (OTR)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:C
Last Name:PYATT
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 E TALL OAKS LN
Mailing Address - Street 2:
Mailing Address - City:ITASCA
Mailing Address - State:IL
Mailing Address - Zip Code:60143-2862
Mailing Address - Country:US
Mailing Address - Phone:630-467-1356
Mailing Address - Fax:630-467-1356
Practice Address - Street 1:322 E TALL OAKS LN
Practice Address - Street 2:
Practice Address - City:ITASCA
Practice Address - State:IL
Practice Address - Zip Code:60143-2862
Practice Address - Country:US
Practice Address - Phone:630-467-1356
Practice Address - Fax:630-467-1356
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics