Healthcare Provider Details

I. General information

NPI: 1164706412
Provider Name (Legal Business Name): AMANDA SPANO M.S, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2011
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 1481
APEX NC
27502-3481
US

IV. Provider business mailing address

4604 SHARPECROFT WAY
HOLLY SPRINGS NC
27540-7169
US

V. Phone/Fax

Practice location:
  • Phone: 199-925-4922
  • Fax:
Mailing address:
  • Phone: 315-264-7822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number9751
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: