Amanda Street, OT

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

OT1818 Issued in MS

Practice address

960 Commonwealth Blvd
Tupelo, MS 38804-9762

Phone

(662) 260-3789

Fax

(662) 260-3790

NPI assigned

Jan 5, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Ms. Amanda Rayborn Former name

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Dpti Elite Physical Therapy LLC

  • Physical Therapist
  • Saltillo, MS
  • NPI 1386010718
  Medicare reassignment NPD
• Drayer Physical Therapy Mississippi LLC

  • Physical Therapist
  • Louisville, MS
  • NPI 1952732448

  Occupational Therapist

  Medicare reassignment NPD
• Dpti Elite Physical Therapy LLC

  • Physical Therapist
  • Baldwyn, MS
  • NPI 1013383496

  Occupational Therapist

  NPD
• Drayer Physical Therapy Mississippi LLC

  • Physical Therapist
  • Crystal Springs, MS
  • NPI 1801333521
  NPD (past)
• Good Samaritan Physical Therapy,Inc.

  • Comprehensive Outpatient Rehabilitation Facility (CORF)
  • Vicksburg, MS
  • NPI 1023087855
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654646400000",
    "number": "1235287517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 822394",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391822394",
            "telephone_number": "601-638-4076",
            "fax_number": "601-638-4979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "960 COMMONWEALTH BLVD",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388049762",
            "telephone_number": "662-260-3789",
            "fax_number": "662-260-3790"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1901 Mission 66",
            "address_2": "Suite A",
            "address_purpose": "LOCATION",
            "city": "Vicksburg",
            "state": "MS",
            "postal_code": "391803711",
            "country_code": "US",
            "telephone_number": "601-638-4076",
            "fax_number": "601-638-4979",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STREET",
        "first_name": "AMANDA",
        "name_prefix": "Mrs.",
        "credential": "OT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-05",
        "last_updated": "2022-06-08",
        "certification_date": "2022-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MS",
            "license": "OT1818",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "000050976",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05037726",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "RAYBORN",
            "prefix": "MS.",
            "credential": "PT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Van D Stone III, M.D.
• William Ross Stone, M.D.
• Lindsie Knowles Story
• Mary Strange
• Karimah Strawder, P.A.
• Eric Street, M.D.
• Kaylee Brenna Strickland, M.ED
• Samantha Strickland
• Courtney Stringer
• Byron Anthony Stutts, PT

• Occupational Therapist in Tupelo, MS
• Providers in Tupelo, MS by specialty
• Occupational Therapist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.