Amanda Durrette Faulkner, MS, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

0119003708 Issued in VA

Practice address

6361 Main St
Gloucester, VA 23061-5166

Phone

(804) 693-2051

NPI assigned

Jan 30, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1517270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1517270400000",
    "number": "1477051951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6099 T C WALKER RD",
            "city": "GLOUCESTER",
            "state": "VA",
            "postal_code": "230614403",
            "telephone_number": "804-693-7944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6361 MAIN ST",
            "city": "GLOUCESTER",
            "state": "VA",
            "postal_code": "230615166",
            "telephone_number": "804-693-2051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAULKNER",
        "first_name": "AMANDA",
        "middle_name": "DURRETTE",
        "name_prefix": "Ms.",
        "credential": "MS, OTR/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-01-30",
        "last_updated": "2018-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "VA",
            "license": "0119003708",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Occupational Therapist in Gloucester, VA
• Providers in Gloucester, VA by specialty
• Occupational Therapist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 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.