Basic Information
| Provider Information | |||||||||
| NPI: | 1881215192 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HITZEMANN | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | OTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4708 CORY ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGDALE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727621807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6143158777 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4313 S PLEASANT CROSSING BLVD | ||||||||
| Address2: | |||||||||
| City: | ROGERS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727581347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4793414003 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2020 | ||||||||
| LastUpdateDate: | 04/28/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XP0019X | 430575 | AR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Physical Rehabilitation |
No ID Information.