Individual
AMANDA LYNN THARALDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTA
Contact information
Practice address
201 EPPES ST, HOPEWELL, VA 23860-2717
(804) 541-1445
Mailing address
3609 KINGS POINT CT APT E, RICHMOND, VA 23223-1680
(386) 747-6587
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
0131001765
VA
Other
Enumeration date
01/04/2023
Last updated
01/04/2023
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