Provider Demographics
NPI:1063831790
Name:COX, AMANDA NICOLE (OTR)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:NICOLE
Last Name:COX
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 S CONWAY PL
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-3159
Mailing Address - Country:US
Mailing Address - Phone:509-222-5028
Mailing Address - Fax:509-222-5056
Practice Address - Street 1:125 S CONWAY PL
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-3159
Practice Address - Country:US
Practice Address - Phone:509-222-5028
Practice Address - Fax:509-222-5056
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-09
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT60450015225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist