MEDICARE: AMANDA CHAMPION M. ED

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	222Q00000X	Developmental Therapist

General Provider Information

NPI Number	:	1518397546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA CHAMPION M. ED

Provider Business Mailing Address
First Line	:	106 CROSSWINDS DR
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33413-2001
Country	:	US
Telephone Number	:	407-489-5638
Fax Number	:

Provider Business Practice Location Address
First Line	:	106 CROSSWINDS DR
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33413-2001
Country	:	US
Telephone Number	:	407-489-5638
Fax Number	:

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

Provider Enumeration Date	:	11/12/2013
Last Update Date	:	11/12/2013

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