Basic Information
| Provider Information | |||||||||
| NPI: | 1265578108 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMAS | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | RAE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | COTL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3560 HWY 47 EAST | ||||||||
| Address2: | |||||||||
| City: | BURNS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6157974290 | ||||||||
| FaxNumber: | 6154413138 | ||||||||
| Practice Location | |||||||||
| Address1: | 812 N CHARLOTTE ST | ||||||||
| Address2: | |||||||||
| City: | DICKSON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370551009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6154468046 | ||||||||
| FaxNumber: | 6154413138 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | COTA1505 | TN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.