Individual
AMANDA LEIGH MCCARTHY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MOTR/L
Contact information
Practice address
5842 HOBE LN, WHITE BEAR LAKE, MN 55110-6477
(651) 383-1197
Mailing address
2563 SUMAC CIR, WHITE BEAR LAKE, MN 55110-5622
(612) 802-2415
Taxonomy
Speciality
Code
Description
License number
State
225XM0800X
Mental Health Occupational Therapist
Primary
104602
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1609320605
EVOLVE WELL OCCUPATIONAL THERAPY
MN
05
—
1609320605
—
MN
Enumeration date
04/08/2018
Last updated
06/16/2018
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