MEDICARE: AMANDA ZLUPKO OTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224Z00000X	Occupational Therapy Assistant	0131001600	VA

General Provider Information

NPI Number	:	1235581406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA ZLUPKO OTA

Provider Business Mailing Address
First Line	:	13714 WATKINS GLEN RD
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23112-4010
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13714 WATKINS GLEN RD
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23112-4010
Country	:	US
Telephone Number	:	180-487-4349
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2016
Last Update Date	:	07/12/2016

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