Individual
AMANDA LEE THEOBALD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
170 TAYLOR STATION RD STE 220, COLUMBUS, OH 43213-4491
(614) 866-8158
Mailing address
2030 KINGMAN CT, LEWIS CENTER, OH 43035-9022
(740) 359-6129
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT006819
OH
Other
Enumeration date
01/27/2020
Last updated
11/27/2023
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