Active NPI
Amanda Susan Marine, ST
- Speech-Language Pathologist
- Altoona, IA
National Provider Identifier
1710124177
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 001851
- Practice address
- 612 8TH St SW
Altoona, IA 50009-2301 - Phone
- (515) 967-4124
- Fax
- (515) 967-9094
- NPI assigned
- Jan 7, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 001851 | IA | Primary |
Addresses
Primary practice location
612 8TH St SW
Altoona, IA 50009-2301
Mailing address
PO Box 461
Nevada, IA 50201-0461
Phone (515) 382-3366
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001851 | IA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1231286400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1231286400000",
"number": "1710124177",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 461",
"city": "NEVADA",
"state": "IA",
"postal_code": "502010461",
"telephone_number": "515-382-3366",
"fax_number": "515-382-1576"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "612 8TH ST SW",
"city": "ALTOONA",
"state": "IA",
"postal_code": "500092301",
"telephone_number": "515-967-4124",
"fax_number": "515-967-9094"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARINE",
"first_name": "AMANDA",
"middle_name": "SUSAN",
"credential": "ST",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-01-07",
"last_updated": "2009-01-07",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IA",
"license": "001851",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Altoona, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.