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General NPI Number Information
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NPI Number | 1386183978
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Entity Type | Individual
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Provider Name | AMANDA KANE ROSEN OTR/L
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Gender | Female
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Dates
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Enumeration Date | 02/16/2017
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Last Update Date | 02/16/2017
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Provider Practice Location Address
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Address Line | 14391 METROPOLIS AVE #101/102
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City | FORT MYERS
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State | FL
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Zip | 33912-4423
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Country | US
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Telephone | 239-561-2778
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Fax | 239-561-8107
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Provider Business Mailing Address
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Address Line | 14391 METROPOLIS AVE #101/102
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City | FORT MYERS
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State | FL
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Zip | 33912-4423
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Country | US
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Telephone | 239-561-2778
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Fax | 239-561-8107
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT18198
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License Number State | FL
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