Provider Demographics
NPI:1235730045
Name:WILLIAMS, AMANDA RENEE (COTA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:RENEE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 LAURELBROOKE DR
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15825-2653
Mailing Address - Country:US
Mailing Address - Phone:814-849-0497
Mailing Address - Fax:
Practice Address - Street 1:MCKINLEY HEALTH CENTER
Practice Address - Street 2:133 LAURELBROOKE DRIVE
Practice Address - City:BROOKVILLE
Practice Address - State:PA
Practice Address - Zip Code:15825-1582
Practice Address - Country:US
Practice Address - Phone:814-849-0497
Practice Address - Fax:814-849-0793
Is Sole Proprietor?:No
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP007802224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant