Provider Demographics
NPI:1780927012
Name:RUTTER, AMANDA (MS, OTR/L)
Entity type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:
Last Name:RUTTER
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 1:3201 VARNUM ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT RAINIER
Mailing Address - State:MD
Mailing Address - Zip Code:20712-1653
Mailing Address - Country:US
Mailing Address - Phone:202-549-1007
Mailing Address - Fax:
Practice Address - Street 1:2301 COLUMBIA PIKE
Practice Address - Street 2:SUITE 125
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204
Practice Address - Country:US
Practice Address - Phone:202-544-5439
Practice Address - Fax:202-379-1797
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-04
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017913-1225X00000X
DCOT010001315225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist