Amanda Van Dyke, MOT, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

325638 Issued in LA

Practice address

1950 E 70TH St Ste a
Shreveport, LA 71105-5345

Phone

(318) 219-6064

NPI assigned

Jan 6, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Amanda Elliott Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

• Jeter Speech Language Pathology Services, LLC

  • Speech-Language Pathologist
  • Shreveport, LA
  • NPI 1851924237

  Occupational Therapist

  NPD

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

{
    "created_epoch": "1578268800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617321600000",
    "number": "1952940173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2303 LEXINGTON DR",
            "city": "BARKSDALE AFB",
            "state": "LA",
            "postal_code": "711102174",
            "telephone_number": "573-406-8378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1950 E 70TH ST STE A",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711055345",
            "telephone_number": "318-219-6064"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1950 E 70th St Ste A",
            "address_purpose": "LOCATION",
            "city": "Shreveport",
            "state": "LA",
            "postal_code": "711055345",
            "country_code": "US",
            "telephone_number": "318-219-6064",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1335 E Republic Rd Ste D",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "MO",
            "postal_code": "658047220",
            "country_code": "US",
            "telephone_number": "417-727-0150",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VAN DYKE",
        "first_name": "AMANDA",
        "credential": "MOT, OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-06",
        "last_updated": "2021-04-02",
        "certification_date": "2021-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "LA",
            "license": "325638",
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MO",
            "license": "2019036905",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "ELLIOTT",
            "credential": "MOT, OTR/L",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Carter Van Horn
• Chuong Van, PHARM D
• Jenna Van, MSN
• Louis Jacob Vanasselberg, MS, LPC, NCC
• Christopher Vance

• Occupational Therapist in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Occupational Therapist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2021; 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.