Provider Demographics
NPI:1518300854
Name:GHILONI, AMANDA C (COTA/L)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:C
Last Name:GHILONI
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 HICKORY LN SW
Mailing Address - Street 2:
Mailing Address - City:PATASKALA
Mailing Address - State:OH
Mailing Address - Zip Code:43062-9221
Mailing Address - Country:US
Mailing Address - Phone:614-844-5433
Mailing Address - Fax:
Practice Address - Street 1:125 DILLMONT DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-4658
Practice Address - Country:US
Practice Address - Phone:614-844-5433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH05184224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant