Provider Demographics
NPI:1619487576
Name:GAY, AMANDA (MS-OTR/L)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:GAY
Suffix:
Gender:F
Credentials:MS-OTR/L
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS-OTR/L
Mailing Address - Street 1:4530 NELSON BROGDON BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-5407
Mailing Address - Country:US
Mailing Address - Phone:678-820-9606
Mailing Address - Fax:844-820-9616
Practice Address - Street 1:4530 NELSON BROGDON BLVD STE C
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-5407
Practice Address - Country:US
Practice Address - Phone:678-820-9606
Practice Address - Fax:844-820-9616
Is Sole Proprietor?:No
Enumeration Date:2017-10-05
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA14110319OtherCAQH