Amanda Fairbanks, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

5201008519 Issued in MI

Practice address

1050 4 Mile Rd NW
Grand Rapids, MI 49544-1505

Phone

(616) 685-7073

NPI assigned

Jul 10, 2018

Last updated

Jul 10, 2018By the provider in NPPES

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 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1531180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531180800000",
    "number": "1316433576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7941 KINMONT CT",
            "city": "JENISON",
            "state": "MI",
            "postal_code": "494289109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1050 4 MILE RD NW",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495441505",
            "telephone_number": "616-685-7073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAIRBANKS",
        "first_name": "AMANDA",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-10",
        "last_updated": "2018-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MI",
            "license": "5201008519",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OCCUPATIONAL THERAPY STATE LICENSURE",
            "identifier": "5201008519",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sarah Elizabeth Fahnhorst, D.O.
• Alicia V Fahr, PH.D. LPC
• Daniel R Fain, MD
• Ayana Fair, LLMSW
• Kaley Suzanne Fairbairn, LMSW
• Ethan Cross Fairbanks, MD
• Haleigh Fairbanks, LLMSW
• David Fairchild II
• Hannah Fairchild, MD
• Kelly J Fairchild, LMSW

• Occupational Therapist in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Occupational Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.