MEDICARE: AMANDA GILL PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	C.1100304	OH

General Provider Information

NPI Number	:	1447643499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA GILL PC

Provider Business Mailing Address
First Line	:	2426 BANBURY RD
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44333-3941
Country	:	US
Telephone Number	:	330-958-1080
Fax Number	:

Provider Business Practice Location Address
First Line	:	2426 BANBURY RD
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44333-3941
Country	:	US
Telephone Number	:	330-958-1080
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2015
Last Update Date	:	03/15/2018

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