Healthcare Provider Details

I. General information

NPI: 1780927012
Provider Name (Legal Business Name): AMANDA RUTTER MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2013
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 COLUMBIA PIKE SUITE 125
ARLINGTON VA
22204
US

IV. Provider business mailing address

3201 VARNUM ST
MOUNT RAINIER MD
20712-1653
US

V. Phone/Fax

Practice location:
  • Phone: 202-544-5439
  • Fax: 202-379-1797
Mailing address:
  • Phone: 202-549-1007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number017913-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT010001315
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: