Provider Demographics
NPI:1811122005
Name:BITTLE, AMANDA DAWN
Entity type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:DAWN
Last Name:BITTLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4310 E 181ST ST S
Mailing Address - Street 2:
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008-5627
Mailing Address - Country:US
Mailing Address - Phone:918-759-1312
Mailing Address - Fax:918-758-0407
Practice Address - Street 1:400 W 6TH ST
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-5000
Practice Address - Country:US
Practice Address - Phone:918-758-4110
Practice Address - Fax:918-758-0407
Is Sole Proprietor?:No
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator