Healthcare Provider Details

I. General information

NPI: 1346612603
Provider Name (Legal Business Name): AMANDA L. PLOURDE COTA/L, CDI, CDRS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA L. WEBB COTA/L

II. Dates (important events)

Enumeration Date: 10/27/2015
Last Update Date: 10/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 BUTLER STREET
SALEM NH
03079-3974
US

IV. Provider business mailing address

70 BUTLER STREET
SALEM NH
03079-3974
US

V. Phone/Fax

Practice location:
  • Phone: 603-893-2900
  • Fax: 603-893-1628
Mailing address:
  • Phone: 603-893-2900
  • Fax: 603-893-1628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number230
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: