Provider Demographics
NPI:1417663113
Name:SAMUELS, AMY MARIE (OTR/L, C/NDT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:SAMUELS
Suffix:
Gender:F
Credentials:OTR/L, C/NDT
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:MARIE
Other - Last Name:ADAMSON COULSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:535 COLISEUM DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31217-0104
Mailing Address - Country:US
Mailing Address - Phone:478-803-7300
Mailing Address - Fax:
Practice Address - Street 1:535 COLISEUM DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-0104
Practice Address - Country:US
Practice Address - Phone:478-803-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT008733225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist