Provider Demographics
NPI:1184151128
Name:GREEN, AMANDA MARIE (MT-BC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:GREEN
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3411 DIVISION DR
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-5789
Mailing Address - Country:US
Mailing Address - Phone:417-257-9162
Mailing Address - Fax:
Practice Address - Street 1:3411 DIVISION DR
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-5789
Practice Address - Country:US
Practice Address - Phone:417-257-9162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-22
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist