Provider Demographics
NPI:1952535692
Name:DUKE, AMANDA TAYLOR (MSOTR/L)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:TAYLOR
Last Name:DUKE
Suffix:
Gender:F
Credentials:MSOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11510 CHICKAHOMINY BRANCH DR
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-5119
Mailing Address - Country:US
Mailing Address - Phone:804-320-2405
Mailing Address - Fax:804-320-2405
Practice Address - Street 1:11510 CHICKAHOMINY BRANCH DR
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-5119
Practice Address - Country:US
Practice Address - Phone:804-320-2405
Practice Address - Fax:804-320-2405
Is Sole Proprietor?:No
Enumeration Date:2009-05-10
Last Update Date:2009-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119002760225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist