MEDICARE: AMANDA SUE ELLIOTT

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	376J00000X	Homemaker

General Provider Information

NPI Number	:	1336838291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA SUE ELLIOTT

Provider Business Mailing Address
First Line	:	8040 UPPER TWIN RD
Second Line	:
City	:	SOUTH SALEM
State	:	OH
Zip	:	45681-9732
Country	:	US
Telephone Number	:	740-253-4146
Fax Number	:

Provider Business Practice Location Address
First Line	:	8040 UPPER TWIN RD
Second Line	:
City	:	SOUTH SALEM
State	:	OH
Zip	:	45681-9732
Country	:	US
Telephone Number	:	740-253-4146
Fax Number	:

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

Provider Enumeration Date	:	05/04/2023
Last Update Date	:	05/08/2023

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Directions to “ AMANDA SUE ELLIOTT ” Practice Location

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