Provider Demographics
NPI:1164706412
Name:SPANO, AMANDA (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:SPANO
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4604 SHARPECROFT WAY
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-7169
Mailing Address - Country:US
Mailing Address - Phone:315-264-7822
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 1481
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-3481
Practice Address - Country:US
Practice Address - Phone:199-925-4922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9751225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist