Individual
AMANDA TILSTRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3064 BRIDGEWATER ST, LANCASTER, SC 29720-0249
(845) 542-0128
Mailing address
3064 BRIDGEWATER ST, LANCASTER, SC 29720-0249
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5577
SC
225XG0600X
Gerontology Occupational Therapist
Primary
5577
SC
Other
Enumeration date
06/27/2019
Last updated
05/14/2026
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