Provider Demographics
NPI:1578722021
Name:MCCOMISH, AMY LEE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LEE
Last Name:MCCOMISH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WHEATON DR
Mailing Address - Street 2:
Mailing Address - City:RICHLANDS
Mailing Address - State:NC
Mailing Address - Zip Code:28574-8192
Mailing Address - Country:US
Mailing Address - Phone:910-200-6190
Mailing Address - Fax:
Practice Address - Street 1:1839 ONSLOW DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-5906
Practice Address - Country:US
Practice Address - Phone:910-455-3610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4579225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist