MEDICARE: MRS. AMANDA WHITLEY OT

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	225X00000X	Occupational Therapist	OT18370	FL
2	225X00000X	Occupational Therapist	OT003606	GA

General Provider Information

NPI Number	:	1588621288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMANDA WHITLEY OT

Provider Business Mailing Address
First Line	:	1040 GULF BREEZE PKWY STE 200
Second Line	:
City	:	GULF BREEZE
State	:	FL
Zip	:	32561-7808
Country	:	US
Telephone Number	:	850-916-3700
Fax Number	:	850-916-3710

Provider Business Practice Location Address
First Line	:	1040 GULF BREEZE PKWY STE 200
Second Line	:
City	:	GULF BREEZE
State	:	FL
Zip	:	32561-7808
Country	:	US
Telephone Number	:	850-916-3700
Fax Number	:	850-916-3710

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

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	07/29/2020

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Directions to “ MRS. AMANDA WHITLEY OT” Practice Location

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