Provider Demographics
NPI:1528810090
Name:MCENTEGART, AMANDA ELIZABETH (MT-BC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:ELIZABETH
Last Name:MCENTEGART
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:ELIZABETH
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MT-BC
Mailing Address - Street 1:600 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:SUDLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21668-1532
Mailing Address - Country:US
Mailing Address - Phone:410-482-9148
Mailing Address - Fax:410-479-8397
Practice Address - Street 1:600 CHARLES ST
Practice Address - Street 2:
Practice Address - City:SUDLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21668-1532
Practice Address - Country:US
Practice Address - Phone:410-482-9148
Practice Address - Fax:410-479-8397
Is Sole Proprietor?:No
Enumeration Date:2024-04-05
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00079225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist