Individual
AMANDA DIZINNO
Active
Individual
AMANDA DIZINNO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LOTR
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10077024
AMERIGROUP
—
01
—
371948
WELLCARE
—
01
—
375135543A
PEACHSTATE
GA
05
—
375135543A
—
GA
Enumeration date
08/30/2006
Last updated
10/27/2010
Update your record
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