MEDICARE: MRS. AMANDA SUE BREDEMEIER OT

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	17-01981	KS
2	225X00000X	Occupational Therapist	1120	NE
3	225X00000X	Occupational Therapist	2007017527	MO

General Provider Information

NPI Number	:	1922162577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMANDA SUE BREDEMEIER OT

Provider Business Mailing Address
First Line	:	700 OREGON ST
Second Line	:
City	:	HIAWATHA
State	:	KS
Zip	:	66434-2232
Country	:	US
Telephone Number	:	785-742-7606
Fax Number	:	785-742-4490

Provider Business Practice Location Address
First Line	:	700 OREGON ST
Second Line	:
City	:	HIAWATHA
State	:	KS
Zip	:	66434-2232
Country	:	US
Telephone Number	:	785-742-7606
Fax Number	:	785-742-4490

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

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	07/31/2013

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