Provider Demographics
NPI:1811140460
Name:INFUSINO, AMANDA L (MS OTR/L)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:L
Last Name:INFUSINO
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:MR
Other - First Name:AMANDA
Other - Middle Name:L
Other - Last Name:TANNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS OTR/L
Mailing Address - Street 1:PO BOX 96
Mailing Address - Street 2:
Mailing Address - City:VERONA BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:13162-0096
Mailing Address - Country:US
Mailing Address - Phone:315-280-4786
Mailing Address - Fax:
Practice Address - Street 1:601 SHERRILL RD
Practice Address - Street 2:
Practice Address - City:SHERRILL
Practice Address - State:NY
Practice Address - Zip Code:13461-1461
Practice Address - Country:US
Practice Address - Phone:315-363-8288
Practice Address - Fax:315-363-8814
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014447225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist