Individual
AMANDA M KEGG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
5202 SAINT JOE RD, SUITE 340, FORT WAYNE, IN 46835-3380
(260) 485-6068
Mailing address
2620 KENWOOD AVE, FORT WAYNE, IN 46805-2841
(260) 241-6240
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
32001579A
IN
Other
Enumeration date
06/29/2011
Last updated
06/29/2011
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