MEDICARE: AMANDA ANN STRATTON MOT, OTR/L

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	0119008958	VA

General Provider Information

NPI Number	:	1497334239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA ANN STRATTON MOT, OTR/L

Provider Business Mailing Address
First Line	:	111 HELEN CT
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-6064
Country	:	US
Telephone Number	:	423-202-5505
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 HELEN CT
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-6064
Country	:	US
Telephone Number	:	423-202-5505
Fax Number	:

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

Provider Enumeration Date	:	04/07/2021
Last Update Date	:	04/07/2021

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