MEDICARE: AMANDA FLETCHER

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	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1356739130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA FLETCHER

Provider Business Mailing Address
First Line	:	78 HARVARD AVE
Second Line	:
City	:	STAMFORD
State	:	CT
Zip	:	06902-5548
Country	:	US
Telephone Number	:	203-422-2193
Fax Number	:

Provider Business Practice Location Address
First Line	:	78 HARVARD AVE
Second Line	:
City	:	STAMFORD
State	:	CT
Zip	:	06902-5548
Country	:	US
Telephone Number	:	203-422-2193
Fax Number	:

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

Provider Enumeration Date	:	01/02/2015
Last Update Date	:	02/26/2020

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