Healthcare Provider Details

I. General information

NPI: 1245638147
Provider Name (Legal Business Name): AMANDA LYNN BORICK MS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2014
Last Update Date: 12/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 PENN AVE
SCRANTON PA
18503-1213
US

IV. Provider business mailing address

401 PENN AVE
SCRANTON PA
18503-1213
US

V. Phone/Fax

Practice location:
  • Phone: 570-961-4300
  • Fax:
Mailing address:
  • Phone: 570-961-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License NumberOC012385
License Number StatePA

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: