Provider Demographics
NPI:1659913770
Name:HAUSER, AMANDA MICHELLE (COTA, LMT)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:MICHELLE
Last Name:HAUSER
Suffix:
Gender:F
Credentials:COTA, LMT
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:MICHELLE
Other - Last Name:NEWBERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA, LMT
Mailing Address - Street 1:413 SANDY HILL WAY
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-6405
Mailing Address - Country:US
Mailing Address - Phone:703-298-7598
Mailing Address - Fax:
Practice Address - Street 1:3630 GEORGE WASHINGTON MEM HWY STE A
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23693-3350
Practice Address - Country:US
Practice Address - Phone:757-867-9424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131001545224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0131001545OtherVIRGINIA DEPARTMENT OF HEALTH PROFESSIONALS