Healthcare Provider Details

I. General information

NPI: 1578485827
Provider Name (Legal Business Name): MRS. AMANDA CARRA RUDISILL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 RACETRACK RD
HANOVER PA
17331-8974
US

IV. Provider business mailing address

58 RACETRACK RD
HANOVER PA
17331-8974
US

V. Phone/Fax

Practice location:
  • Phone: 717-353-1924
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-467955
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: