MEDICARE: AMANDA KAIZ

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	2355S0801X	Speech-Language Assistant
2	224Z00000X	Occupational Therapy Assistant

General Provider Information

NPI Number	:	1992131007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA KAIZ

Provider Business Mailing Address
First Line	:	3019 N WILSHIRE LN
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-1749
Country	:	US
Telephone Number	:	847-322-5247
Fax Number	:

Provider Business Practice Location Address
First Line	:	3019 N WILSHIRE LN
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-1749
Country	:	US
Telephone Number	:	847-322-5247
Fax Number	:

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

Provider Enumeration Date	:	09/20/2013
Last Update Date	:	06/10/2019

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Directions to “ AMANDA KAIZ ” Practice Location

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