MEDICARE: AMANDA PRATT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224Z00000X	Occupational Therapy Assistant	215125	TX

General Provider Information

NPI Number	:	1043979909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA PRATT

Provider Business Mailing Address
First Line	:	2822 FOSTER AVE
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76308-3619
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2822 FOSTER AVE
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76308-3619
Country	:	US
Telephone Number	:	940-303-9182
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2021
Last Update Date	:	12/08/2021

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Directions to “ AMANDA PRATT ” Practice Location

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