Provider Demographics
NPI:1659920619
Name:ABBOTT, AMELIA M (COTA/L)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:M
Last Name:ABBOTT
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 1:120 MELROSE DRIVE
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:WV
Mailing Address - Zip Code:25086
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:120 MELROSE DRIVE
Practice Address - Street 2:GLASGOW HEALTH AND REHAB CARE
Practice Address - City:GLASGOW
Practice Address - State:WV
Practice Address - Zip Code:25086
Practice Address - Country:US
Practice Address - Phone:304-595-1155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVC1766224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVC1766OtherCOTA/L