Healthcare Provider Details

I. General information

NPI: 1376909010
Provider Name (Legal Business Name): AMANDA LATIMER OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2016
Last Update Date: 02/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 WALNUT ST
HOWE TX
75459
US

IV. Provider business mailing address

PO BOX 384
SHERMAN TX
75091-0384
US

V. Phone/Fax

Practice location:
  • Phone: 903-744-4421
  • Fax:
Mailing address:
  • Phone: 903-744-4421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: