Provider Demographics
NPI:1952557431
Name:MOTAMEDI, AMANDA LEE (OTR)
Entity Type:Individual
Prefix:
First Name:AMANDA LEE
Middle Name:
Last Name:MOTAMEDI
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 1:2292 FIESBECK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-2566
Mailing Address - Country:US
Mailing Address - Phone:812-343-6374
Mailing Address - Fax:
Practice Address - Street 1:2292 FIESBECK DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-2566
Practice Address - Country:US
Practice Address - Phone:812-343-6374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-15
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31004459A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist