Provider Demographics
NPI:1841770153
Name:ERWIN, AMANDA SUZANNE (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:SUZANNE
Last Name:ERWIN
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 JOHNSON FERRY PL STE G10
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-2045
Mailing Address - Country:US
Mailing Address - Phone:770-321-6705
Mailing Address - Fax:404-551-3891
Practice Address - Street 1:1230 JOHNSON FERRY PL STE G10
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-2045
Practice Address - Country:US
Practice Address - Phone:770-321-6705
Practice Address - Fax:404-551-3891
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT007109225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist