Provider Demographics
NPI:1902481534
Name:ARREDONDO, AMANDA BRIDGETT
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:BRIDGETT
Last Name:ARREDONDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 HOUGHTON RD APT 1201
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-3055
Mailing Address - Country:US
Mailing Address - Phone:806-730-0614
Mailing Address - Fax:
Practice Address - Street 1:1111 HOUGHTON RD APT 1201
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-3055
Practice Address - Country:US
Practice Address - Phone:806-730-0614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX216700224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant