Provider Demographics
NPI:1174160113
Name:TWELE, AMANDA MICHELLE (OT/L)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:MICHELLE
Last Name:TWELE
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2338 YADKIN AVE APT 301
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-1888
Mailing Address - Country:US
Mailing Address - Phone:704-564-7082
Mailing Address - Fax:
Practice Address - Street 1:2425 SATCHEL LN
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-2860
Practice Address - Country:US
Practice Address - Phone:704-564-7082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12961225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist