Individual
AMANDA VAN DYKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MOT, OTR/L
Contact information
Practice address
1950 E 70TH ST STE A, SHREVEPORT, LA 71105-5345
(318) 219-6064
Mailing address
2303 LEXINGTON DR, BARKSDALE AFB, LA 71110-2174
(573) 406-8378
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
2019036905
MO
225X00000X
Occupational Therapist
Primary
325638
LA
Other
Enumeration date
01/06/2020
Last updated
04/02/2021
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