Provider Demographics
NPI:1962859819
Name:WRIGHT, AMIA
Entity Type:Individual
Prefix:MS
First Name:AMIA
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 DUNBAR ST
Mailing Address - Street 2:
Mailing Address - City:GRAMBLING
Mailing Address - State:LA
Mailing Address - Zip Code:71245-2206
Mailing Address - Country:US
Mailing Address - Phone:318-341-7615
Mailing Address - Fax:
Practice Address - Street 1:140 DUNBAR ST
Practice Address - Street 2:
Practice Address - City:GRAMBLING
Practice Address - State:LA
Practice Address - Zip Code:71245-2206
Practice Address - Country:US
Practice Address - Phone:318-341-7615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-20
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist