Individual
MISS AMANDA JOY FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
685 CITADEL DR E STE 250, COLORADO SPRINGS, CO 80909-5396
(719) 685-7890
Mailing address
1129 STANTON ST, COLORADO SPRINGS, CO 80907-4677
(616) 648-0301
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OT.0005616
CO
Other
Enumeration date
11/09/2018
Last updated
11/09/2018
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