MEDICARE: AMANDA PARKER

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	225XM0800X	Mental Health Occupational Therapist	07250	MD

General Provider Information

NPI Number	:	1558740712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA PARKER

Provider Business Mailing Address
First Line	:	9525 WHITE SPRING WAY
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21046-2063
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9525 WHITE SPRING WAY
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21046-2063
Country	:	US
Telephone Number	:	301-785-9093
Fax Number	:

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

Provider Enumeration Date	:	05/21/2015
Last Update Date	:	05/21/2015

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Directions to “ AMANDA PARKER ” Practice Location

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