Provider Demographics
NPI:1174287056
Name:ABEL, AMANDA RAE
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:RAE
Last Name:ABEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 SUMMIT RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-9260
Mailing Address - Country:US
Mailing Address - Phone:918-718-1515
Mailing Address - Fax:
Practice Address - Street 1:103 SUMMIT RIDGE DR
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-9260
Practice Address - Country:US
Practice Address - Phone:918-718-1515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist