Amanda Lynn Ketelsen, OTR

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

Practice address

11210 95TH St
Coal Valley, IL 61240-9360

Phone

(309) 799-3161

NPI assigned

Jun 25, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1182729600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1851597983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26535 225TH ST",
            "city": "LECLAIRE",
            "state": "IA",
            "postal_code": "527539720",
            "telephone_number": "563-289-2076"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11210 95TH ST",
            "city": "COAL VALLEY",
            "state": "IL",
            "postal_code": "612409360",
            "telephone_number": "309-799-3161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KETELSEN",
        "first_name": "AMANDA",
        "middle_name": "LYNN",
        "name_prefix": "Ms.",
        "credential": "OTR",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-06-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "IA",
            "license": "01734",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Merritt Fisher, APRN
• Michelle L. Franklin, D.C.
• Koren Fuller
• Elizabeth S Heisler
• Jennifer Anne Hoffman
• Jennifer Marie Klocke, OTR/L
• Aubree Jo Savage Krol
• Victoria Lee Lawson, COTA/L
• William C McCabe, M.D.
• Sarah Elizabeth McShane, P.T.A.

• Occupational Therapist in Coal Valley, IL
• Providers in Coal Valley, IL by specialty
• Occupational Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.