Healthcare Provider Details

I. General information

NPI: 1154238020
Provider Name (Legal Business Name): AMANDA ABBOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 GILLOCK RD
CARROLLTON KY
41008-9511
US

IV. Provider business mailing address

179 GILLS RIDGE RD
BEDFORD KY
40006-8856
US

V. Phone/Fax

Practice location:
  • Phone: 317-556-4507
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: