Provider Demographics
NPI:1811148331
Name:WELLS, AMANDA LAWRENCE (OTR)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LAWRENCE
Last Name:WELLS
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:PO BOX 1468
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-1468
Mailing Address - Country:US
Mailing Address - Phone:830-816-2611
Mailing Address - Fax:830-816-2688
Practice Address - Street 1:34910 INTERSTATE 10 W
Practice Address - Street 2:SUITE 401
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-9229
Practice Address - Country:US
Practice Address - Phone:830-816-2611
Practice Address - Fax:830-816-2688
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110042225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist