MEDICARE: MRS. AMANDA JO SHERWOOD OTR

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	115712	TX

General Provider Information

NPI Number	:	1447601646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMANDA JO SHERWOOD OTR

Provider Business Mailing Address
First Line	:	609 BRITISH CT
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76002-2837
Country	:	US
Telephone Number	:	806-640-7965
Fax Number	:

Provider Business Practice Location Address
First Line	:	6150 OAKMONT TRL
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-2841
Country	:	US
Telephone Number	:	817-292-2006
Fax Number	:

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

Provider Enumeration Date	:	06/29/2016
Last Update Date	:	06/29/2016

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