Healthcare Provider Details

I. General information

NPI: 1417359068
Provider Name (Legal Business Name): AMANDA AMO OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2014
Last Update Date: 09/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 LILLY POND LANE
GOSHEN MA
01032-0716
US

IV. Provider business mailing address

PO BOX 716
GOSHEN MA
01032-0716
US

V. Phone/Fax

Practice location:
  • Phone: 413-336-4900
  • Fax:
Mailing address:
  • Phone: 413-336-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: