Basic Information
| Provider Information | |||||||||
| NPI: | 1215465331 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | PATANIO | ||||||||
| FirstName: | AMANDA | ||||||||
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| Credential: | COTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1025 EAGLE LAKE TRL APT 304 | ||||||||
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| City: | PORT ORANGE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321294192 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 615 RIDGE RD | ||||||||
| Address2: | PERSON MEMORIAL HOSPITAL | ||||||||
| City: | ROXBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27573 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3365992121 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2017 | ||||||||
| LastUpdateDate: | 06/02/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.