Provider Demographics
NPI:1548533136
Name:O'BRIEN, AMANDA M (OTR/L)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:M
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:M
Other - Last Name:BAIR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:9102 E WINDWOOD CT
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-1511
Mailing Address - Country:US
Mailing Address - Phone:316-691-1112
Mailing Address - Fax:
Practice Address - Street 1:9102 E WINDWOOD CT
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-1511
Practice Address - Country:US
Practice Address - Phone:316-691-1112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-01898225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist