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General NPI Number Information
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NPI Number | 1669854428
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Entity Type | Individual
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Provider Name | AMANDA AFFETTO OTR/L
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Gender | Female
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Dates
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Enumeration Date | 06/29/2015
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Last Update Date | 06/29/2015
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Provider Practice Location Address
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Address Line | 2319 N ORCHARD ST
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City | CHICAGO
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State | IL
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Zip | 60614-3303
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Country | US
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Telephone | 773-755-7793
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Fax |
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Provider Business Mailing Address
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Address Line | 1418 PETERSON AVE
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City | PARK RIDGE
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State | IL
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Zip | 60068-5056
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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 | 056.010627
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License Number State | IL
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