MEDICARE: AMANDA POE

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	120251	TX

General Provider Information

NPI Number	:	1750975728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA POE

Provider Business Mailing Address
First Line	:	2207 COUNTRY CREEK WAY
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77406-6611
Country	:	US
Telephone Number	:	214-514-8276
Fax Number	:

Provider Business Practice Location Address
First Line	:	7514 KINGSLEY ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77087-4412
Country	:	US
Telephone Number	:	713-644-8393
Fax Number	:

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

Provider Enumeration Date	:	02/21/2021
Last Update Date	:	02/21/2021

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Directions to “ AMANDA POE ” Practice Location

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