Provider Demographics
NPI:1710386792
Name:STOLZ, AMANDA (COMS)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:STOLZ
Suffix:
Gender:F
Credentials:COMS
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9 SHADETREE CT
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29651-6864
Mailing Address - Country:US
Mailing Address - Phone:305-332-5011
Mailing Address - Fax:
Practice Address - Street 1:10990 BELTON HONEA PATH HWY
Practice Address - Street 2:
Practice Address - City:HONEA PATH
Practice Address - State:SC
Practice Address - Zip Code:29654-9506
Practice Address - Country:US
Practice Address - Phone:305-332-5011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-15
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6160225CX0006X
SC6160225CX0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225CX0006XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorOrientation and Mobility Training Provider