Individual
AMANDA ELIZABETH DODGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C.O.T.A/L
Contact information
Practice address
23 MAHAN ST, LEBANON, NH 03766-1315
(603) 443-9639
Mailing address
76 OLIVE ST, SPRINGFIELD, VT 05156-3251
(802) 376-0021
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
073.0044975
VT
Other
Enumeration date
10/20/2010
Last updated
10/20/2010
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