Provider Demographics
NPI:1982870135
Name:RHOADES, AMANDA SUE (OT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:SUE
Last Name:RHOADES
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 E PARTRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:METAMORA
Mailing Address - State:IL
Mailing Address - Zip Code:61548-9619
Mailing Address - Country:US
Mailing Address - Phone:309-367-4300
Mailing Address - Fax:309-367-2235
Practice Address - Street 1:1200 E PARTRIDGE ST
Practice Address - Street 2:
Practice Address - City:METAMORA
Practice Address - State:IL
Practice Address - Zip Code:61548-9619
Practice Address - Country:US
Practice Address - Phone:309-367-4300
Practice Address - Fax:309-367-2235
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056006677225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist