Provider Demographics
NPI:1841941986
Name:SHANKS, AMANDA MARIE (MS, OTR/L)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:MARIE
Last Name:SHANKS
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:PO BOX 80
Mailing Address - Street 2:
Mailing Address - City:MILLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:12545-0080
Mailing Address - Country:US
Mailing Address - Phone:845-332-9290
Mailing Address - Fax:
Practice Address - Street 1:27 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07424-5603
Practice Address - Country:US
Practice Address - Phone:551-247-1306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR01031100225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist