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General NPI Number Information
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NPI Number | 1477173227
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Entity Type | Individual
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Provider Name | ALEXIS AMENDOLA
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Gender | Female
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Dates
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Enumeration Date | 04/22/2020
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Last Update Date | 11/08/2023
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Provider Practice Location Address
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Address Line | 302 BURWASH AVE
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City | SAVOY
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State | IL
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Zip | 61874-9572
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Country | US
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Telephone | 217-402-9700
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Fax |
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Provider Business Mailing Address
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Address Line | 31 SALVATORE DR
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City | NORTH HAVEN
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State | CT
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Zip | 06473-4111
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Country | US
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Telephone |
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Fax |
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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 | OTH-008848
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License Number State | AZ
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