MEDICARE: AMANDA TOMLINSON

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	235Z00000X	Speech-Language Pathologist	A6M130200248	WV

General Provider Information

NPI Number	:	1750708327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA TOMLINSON

Provider Business Mailing Address
First Line	:	300 SEVILLE RD
Second Line	:
City	:	HURRICANE
State	:	WV
Zip	:	25526-9206
Country	:	US
Telephone Number	:	304-757-6805
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 PRIDE AVE
Second Line	:
City	:	BUNKER HILL
State	:	WV
Zip	:	25413-3578
Country	:	US
Telephone Number	:	304-229-1965
Fax Number	:

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

Provider Enumeration Date	:	03/21/2014
Last Update Date	:	06/18/2014

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Directions to “ AMANDA TOMLINSON ” Practice Location

Language	Start Address	Practice Location

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