Amanda Wallace

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

1905 Issued in WV

Practice address

829 Fairmont Rd
Morgantown, WV 26501-0088

Phone

(304) 305-1506

NPI assigned

Oct 6, 2022

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

Electronic endpoints 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": "1665014400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665014400000",
    "number": "1972228534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26 KIMBERLY CIR",
            "city": "FAIRMONT",
            "state": "WV",
            "postal_code": "265547998",
            "telephone_number": "304-677-9611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "829 FAIRMONT RD",
            "city": "MORGANTOWN",
            "state": "WV",
            "postal_code": "265010088",
            "telephone_number": "304-305-1506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "AMANDA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-10-06",
        "last_updated": "2022-10-06",
        "certification_date": "2022-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "WV",
            "license": "1905",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WVBOT",
            "identifier": "1905",
            "state": "WV"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "QLIQ",
            "affiliation": "N",
            "endpointDescription": "secured messenger",
            "address_1": "829 Fairmont Rd",
            "city": "Morgantown",
            "state": "WV",
            "country_code": "US",
            "postal_code": "265010088",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jeremie A Walker, M.D.
• Joyce Walker, RN
• Nicole Walker
• Nikita Sue-Ann Walker
• Andrew Wall, MD
• Kimberly Ann Wallace, NP-C
• Janet Walleck, CRNA
• Wallflower Connection Therapy Services PLLC
• Barry David Walling, MD
• Elizabeth Walling, LGSW

• Occupational Therapist in Morgantown, WV
• Providers in Morgantown, WV by specialty
• Occupational Therapist in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2022; 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.