Provider Demographics
NPI:1255881223
Name:PETTY, AMY LEE (COTA/L)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LEE
Last Name:PETTY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:LEE
Other - Last Name:BAILY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:1016 DOUGLAS CT
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-1661
Mailing Address - Country:US
Mailing Address - Phone:615-788-9820
Mailing Address - Fax:
Practice Address - Street 1:812 N CHARLOTTE ST
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-1009
Practice Address - Country:US
Practice Address - Phone:615-446-8046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1236224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant