Healthcare Provider Details

I. General information

NPI: 1447141411
Provider Name (Legal Business Name): AMANDA ZILLIKEN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2025
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W 1ST ST STE 301&302
FARMINGTON MO
63640-2528
US

IV. Provider business mailing address

629 MAPLE VALLEY DR STE 53
FARMINGTON MO
63640-1993
US

V. Phone/Fax

Practice location:
  • Phone: 636-495-5375
  • Fax:
Mailing address:
  • Phone: 636-258-2105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2025010543
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: