Provider Demographics
NPI:1295262756
Name:WATKINS, AMANDA KAY (COTA/L)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:KAY
Last Name:WATKINS
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 1:2204 DOWELL BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-1537
Mailing Address - Country:US
Mailing Address - Phone:931-698-1462
Mailing Address - Fax:
Practice Address - Street 1:244 OAKWOOD DR
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:TN
Practice Address - Zip Code:37091-3153
Practice Address - Country:US
Practice Address - Phone:931-359-3563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-16
Last Update Date:2017-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2021224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant