Provider Demographics
NPI:1811248602
Name:BIRD BLEVINS, AMANDA BROOKE (OTD, OTR/L)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:BROOKE
Last Name:BIRD BLEVINS
Suffix:
Gender:F
Credentials:OTD, 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:PO BOX 193
Mailing Address - Street 2:
Mailing Address - City:EMORY
Mailing Address - State:VA
Mailing Address - Zip Code:24327-0193
Mailing Address - Country:US
Mailing Address - Phone:276-614-8567
Mailing Address - Fax:
Practice Address - Street 1:15051 HARMONY HILLS LN
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24211-7661
Practice Address - Country:US
Practice Address - Phone:276-614-8567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-20
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA011905424225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist