Provider Demographics
NPI:1730520982
Name:MCLEAN, AMANDA MARIE (COTA/L)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:MARIE
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 VAN REED RD
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1751
Mailing Address - Country:US
Mailing Address - Phone:610-763-5511
Mailing Address - Fax:
Practice Address - Street 1:101 STATE STREET
Practice Address - Street 2:
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348
Practice Address - Country:US
Practice Address - Phone:866-745-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP007367224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant