Provider Demographics
NPI:1750716874
Name:LINCK, AMANDA K (OT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:K
Last Name:LINCK
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E ROSEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47129-1741
Mailing Address - Country:US
Mailing Address - Phone:812-207-3792
Mailing Address - Fax:
Practice Address - Street 1:325 E LEWIS AND CLARK PKWY
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47129-1725
Practice Address - Country:US
Practice Address - Phone:812-283-3231
Practice Address - Fax:812-283-3271
Is Sole Proprietor?:No
Enumeration Date:2013-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31005478A225X00000X
WV1676225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810026488Medicaid
OH0094895Medicaid
WV3810026488Medicaid