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General NPI Number Information
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NPI Number | 1831284017
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Entity Type | Individual
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Provider Name | AMANDA WICKENKAMP OTR
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Gender | Female
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 08/31/2011
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Provider Practice Location Address
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Address Line | 1515 WAZEE STREET SUITE D
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City | DENVER
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State | CO
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Zip | 80202-1478
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Country | US
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Telephone | 303-534-9553
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Fax | 720-932-8815
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Provider Business Mailing Address
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Address Line | 4900 S MONACO ST SUITE 210
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City | DENVER
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State | CO
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Zip | 80237-3486
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Country | US
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Telephone | 303-534-9553
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Fax | 720-932-8815
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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 | 31004359A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 225XH1200X
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Taxonomy Name | Hand Occupational Therapist
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License Number | 31004359A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 1072823
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License Number State | OR
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