Individual ProviderAmanda Van DykeOccupational TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPractice Address1950 E 70th St Ste A, Shreveport, LA 71105-5345(318) 219-6064(573) 406-8378PECOS EnrollmentBased on the most recent information from CMS, provider Amanda Van Dyke does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1952940173Provider TypeIndividualFull NameVan Dyke, AmandaCredentialMOT, OTR/LGenderFemaleSole ProprietorNoEnumeration Date1/6/2020Last Updated4/2/2021Contact InformationPractice LocationPractice Address1950 E 70th St Ste A, Shreveport, LA 71105-5345Phone(318) 219-6064FaxUnlisted FaxMailing LocationMailing Address2303 Lexington Dr, Barksdale Afb, LA 71110-2174Phone(573) 406-8378FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode225X00000XPrimaryDescriptionOccupational TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicense325638LouisianaCode225X00000XDescriptionOccupational TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicense2019036905Missouri