Individual
MISS AMANDA C ELDRIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1000 E LIONS CLUB DR, ROLLA, MO 65401-4356
(573) 308-5350
Mailing address
1519 PERSHING PL APT D, ROLLA, MO 65401-2675
(573) 308-5350
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2009025180
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2009025180
OCCUPATIONAL THERAPY ASSISTANT
MO
Enumeration date
08/16/2021
Last updated
09/02/2021
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