Provider Demographics
NPI:1730328246
Name:O'CONNOR, AMANDA GAIL (LMT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:GAIL
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 FUNDY RD STE 105
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-1778
Mailing Address - Country:US
Mailing Address - Phone:207-781-2370
Mailing Address - Fax:
Practice Address - Street 1:4 FUNDY RD STE 105
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1778
Practice Address - Country:US
Practice Address - Phone:207-781-2370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-08
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT1718174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist