Provider Demographics
NPI:1639991656
Name:KEY, AMANDA (COTA/L)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:KEY
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 1:107 OAK ST
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30747-2140
Mailing Address - Country:US
Mailing Address - Phone:706-936-4007
Mailing Address - Fax:
Practice Address - Street 1:107 OAK ST
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:GA
Practice Address - Zip Code:30747-2140
Practice Address - Country:US
Practice Address - Phone:706-936-4007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-30
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1111224Z00000X
GAOTA001918224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant