Provider Demographics
NPI:1710084637
Name:WARD, AMY BETH (COTA/L)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:BETH
Last Name:WARD
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 1:212 DAIRWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29680-7831
Mailing Address - Country:US
Mailing Address - Phone:864-704-8781
Mailing Address - Fax:
Practice Address - Street 1:2203 MARCHBANKS AVE
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-2247
Practice Address - Country:US
Practice Address - Phone:864-231-7786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2624224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant