Healthcare Provider Details

I. General information

NPI: 1679918718
Provider Name (Legal Business Name): AMANDA BETH LYTZ M.S., OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2013
Last Update Date: 05/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 SUMMIT AVE SUITE B
ASHEVILLE NC
28803-1938
US

IV. Provider business mailing address

9 SUMMIT AVE SUITE B
ASHEVILLE NC
28803-1938
US

V. Phone/Fax

Practice location:
  • Phone: 828-670-8056
  • Fax: 828-670-8057
Mailing address:
  • Phone: 828-670-8056
  • Fax: 828-670-8057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number8669
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number8669
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: