Provider Demographics
NPI:1558560656
Name:MAES, AMANDA JO (COTA)
Entity Type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:JO
Last Name:MAES
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 1:506 SHADOW OAKS CT
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-3146
Mailing Address - Country:US
Mailing Address - Phone:214-621-6074
Mailing Address - Fax:
Practice Address - Street 1:506 SHADOW OAKS CT
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-3146
Practice Address - Country:US
Practice Address - Phone:214-621-6074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2007-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX209673224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant