Provider Demographics
NPI:1124590435
Name:PROCTOR, AMY L (COTA/L)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:PROCTOR
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:L
Other - Last Name:MUZIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:346 E RAILROAD ST APT 12
Mailing Address - Street 2:
Mailing Address - City:GETTYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17325-1608
Mailing Address - Country:US
Mailing Address - Phone:301-399-7631
Mailing Address - Fax:
Practice Address - Street 1:867 YORK RD
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325
Practice Address - Country:US
Practice Address - Phone:301-399-7631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-27
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA01704224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant