Individual
MRS. AMANDA A PETKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
226 S ANDERSON ST STE B, ELWOOD, IN 46036-2015
(765) 552-8460
(765) 552-8470
Mailing address
226 S ANDERSON ST STE B, ELWOOD, IN 46036-2015
(765) 552-8460
(765) 552-8470
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
31004646A
IN
225XH1200X
Hand Occupational Therapist
Primary
31004646A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00702440
RR MEDICARE
IN
Enumeration date
06/03/2008
Last updated
01/26/2011
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