Provider Demographics
NPI:1447713714
Name:BAKER, AMANDA O (OTA/L)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:O
Last Name:BAKER
Suffix:
Gender:F
Credentials:OTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5233 VICTORIA ST NW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24017-4209
Mailing Address - Country:US
Mailing Address - Phone:540-986-6882
Mailing Address - Fax:
Practice Address - Street 1:5223 VICTORIA ST NW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24017-4209
Practice Address - Country:US
Practice Address - Phone:540-986-6882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-12
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131000387224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant