MEDICARE: AMANDA MACEWEN OTR/L

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	225X00000X	Occupational Therapist	OT4561	NM

General Provider Information

NPI Number	:	1548926140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA MACEWEN OTR/L

Provider Business Mailing Address
First Line	:	12127 HWY 14 N STE B3
Second Line	:
City	:	CEDAR CREST
State	:	NM
Zip	:	87008-9462
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12127 HWY 14 N STE B3
Second Line	:
City	:	CEDAR CREST
State	:	NM
Zip	:	87008-9462
Country	:	US
Telephone Number	:	505-286-3678
Fax Number	:

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

Provider Enumeration Date	:	11/09/2021
Last Update Date	:	11/09/2021

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Directions to “ AMANDA MACEWEN OTR/L” Practice Location

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