Provider Demographics
NPI:1730350802
Name:WILKENING, AMANDA JEAN (MOTR/L)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:JEAN
Last Name:WILKENING
Suffix:
Gender:
Credentials:MOTR/L
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:JEAN
Other - Last Name:SENAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MOTR/L
Mailing Address - Street 1:150 SAINT ANDREWS CT
Mailing Address - Street 2:SUITE 310
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-8659
Mailing Address - Country:US
Mailing Address - Phone:507-388-5437
Mailing Address - Fax:507-388-2108
Practice Address - Street 1:150 SAINT ANDREWS CT
Practice Address - Street 2:SUITE 310
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-8659
Practice Address - Country:US
Practice Address - Phone:507-388-5437
Practice Address - Fax:507-388-2108
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1451225X00000X
MN103485225X00000X
AROTR2417225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR187 988 721Medicaid