Provider Demographics
NPI:1871916460
Name:KOENIG, AMANDA MARIE (MOTR/L)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:KOENIG
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:463 K RD
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:NE
Mailing Address - Zip Code:68418-4072
Mailing Address - Country:US
Mailing Address - Phone:402-540-0834
Mailing Address - Fax:
Practice Address - Street 1:420 E 11TH ST
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-3364
Practice Address - Country:US
Practice Address - Phone:402-540-0834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-02
Last Update Date:2014-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002433225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist